Table of Contents
Journal of Critical Care Medicine
Volume 2015, Article ID 526319, 5 pages
Research Article

Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

1Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, USA
2Department of Neurology, Columbia University, New York, NY, USA
3Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, USA
4Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
5Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

Received 29 August 2014; Revised 19 December 2014; Accepted 20 December 2014

Academic Editor: Ricardo Rivera-Fernández

Copyright © 2015 Erica M. Jones et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods. Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results. Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death. Conclusions. Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.