M Asim Rana, Tahira Bibi, M A Qayyum, M Javed, Saba Zartash5, A A Lashari, R Pervaiz, M M Hafeez
Aim: To understand the effect of time spent or the delays in emergency department after presenting to emergency, before being shifted to ICU on the outcome of patients in terms of mortality, length of stay in ICU and in hospital. Study design: Retrospective analysis of medical records Method: This retrospective study was done in the Departments of Emergency and Intensive Care from 1st January 2019 to 30th November 2020. Nine hundred and forty patients were included. All the records were reviewed in terms of the time of admission, the reason of admission, and the waiting or stand-by times in the Emergency Department. All included patients were divided into three different groups depending upon their time of stay in Emergency Department.
Results: Four hundred and sixty (48.93%) were admitted to ICU within 6 hours, 227(24.14%) within 6 to 10 hours and 253 (26.93%) after 10 hours. Patients who were shifted to ICU in time span of 6 hours were young [49.0±23.3classified as group I), 52.6±22.6 were shifted after 6 but less than 10 hours were labelled as group II, and those who stayed in emergency for more than 10 hours before moving to ICU were 58.8±20.9 and collected in group III (P=0.05)]. Group I had less mechanical ventilation duration [6±8.7days as compared to group II 7.2±8.8 and group III 10.6±11.2 (P=0.04). Higher mortality was noted in group III [101(21.90%), 130(57.26%), 171 (67.55), P=0.006). Similarly, length of stay in ICU (ICU-LOS) was longer in group III, 9.55 days were noted for Group I, 12.3 days for Group II and 13.6 days were found for Group III, (P=0.002). Conclusion: Longer duration of time stay in emergency department before shifting to ICU (> 3.0 hours) is found to be associated with rise in mortality, especially in patients who exhibited higher acute physiology and chronic health evaluation (APACHE) IV score. Keywords: Mortality, Critically sick patients, APACHE IV, Emergency department, Intensive care unit,