From emergency department to intensive care unit, does the delay matter to trauma patients?

Abstract

Introduction: Emergency department (ED) overcrowding with critically ill trauma patients has been a major concern globally. It has been shown that longer stays in the hospital before Intensive Care Unit (ICU) admission have a higher mortality rate. Objective: The objective of this study was to find whether the delay in ICU admission from ED is associated with significant mortality in a trauma patient. Methods: A prospective trauma registry data of 232 patients collected from the ED of JPNATC trauma center between September 2015 and March 2016 were used in the study. The study participants were all admitted trauma patients. Dead-on-arrival patients were excluded from the study. Results: All included patients had a blunt injury at the time of arrival. Of 232 patients, 66 died during treatment and 166 were discharged. Of these, 196 (84.5%) were male and 36 (15.5%) were female. Most of the patients among 66 who died were referred from different hospitals; however, most survivors arrived directly at JPNATC as compared to another group (P < 0.001). Waiting time in ED was calculated by the difference between arrival time and ED disposition time. There was statistically significant difference found in ED waiting time in both the groups (P = 0.015); however, the odds ratio is closer to 1, that is, 0.998. Similarly, age, gender, oxygen saturation, Glasgow Coma Scale, ICU stay days, heart rate, referring status, and injury severity score were found to be significant at the level of 25% under univariate analysis. Conclusion: The ED delay is not associated with adverse outcome in terms of mortality. Other factors may play a much greater role in determining the prognosis.

Keywords

• Emergency department
• Intensive Care Unit
• trauma registry