Emergency Department Length of Stay and Outcome after Ischemic Stroke

Background: Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. Methods: This study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score > 2), respectively. Results: The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n = 160) versus the neuroscience intensive care unit (NICU; n = 165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P < .001), endovascular stroke therapy (P = .001), and thrombolysis (P = .021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P = .048). On multivariable logistic regression, a greater admission National Institutes of Health Stroke Scale score (P <.001), worse pre-admission mRS score (P = .001), hemorrhagic conversion (P = .041), and a shorter ED-LOS (P = .016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P = .049), endovascular stroke therapy (P = .041), NICU admission (P = .029), and evening shift presentation (P = .035) were associated with a good 90-day outcome. Conclusions: In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk of a poor functional outcome.