Abstract
Background and objective
The boarding of critically ill patients in the emergency department (ED) has been on the rise over the past few years. Emergency physicians now frequently encounter critically ill patients who require rapid resuscitation and stabilization and they provide extended care in the ED. This study aimed to evaluate the association between the boarding duration of mechanically ventilated patients in the ED and outcomes in such patients.
Methods
This was a retrospective study conducted during the period 2018-2019 at an academic institution; it included adult patients who were mechanically ventilated, requiring and awaiting admission to the ICU from the ED.
Results
We included a total of 388 out of 537 patients in the analysis. Patients were stratified into three groups as follows: 93 (24%) were admitted to the ICU within six hours; 126 (32.5%) were admitted to the ICU within 6-24 hours; and 169 (43.6%) were admitted to the ICU after 24 hours. Patients admitted to the ICU within six hours were significantly younger; the mean age of the patients was 55 +/- 16.30 years in group 1, 61.96 +/- 17.73 years in group 2, and 62.65 +/- 16.62 years in group 3 (p-0.001). The ICU mortality in group 1 was lower than in other groups, and mortality increased with increasing boarding time [28 (30.1%), 51 (40.5%), 79 (46.7%), respectively, p=0.0321. Boarding time in the ED was associated with an increased risk of ICU mortality in group 3 compared with group 1 (0.1664 +/- 0.063, p=0.009). The logistic regression analysis showed higher mortality rates in groups 2 [adjusted odds ratio: 3.29; 95% confidence interval (CI): 1.95-5.55, p<0.01) and 3 (adjusted odds ratio: 1.98; 95% CI: 1.17-3.35, p=0.01).
Conclusion
Based on our findings from this small-sample, single-center study, ED boarding of mechanically ventilated patients is associated with higher ICU mortality rates.