The association between length of stay in the emergency department and mortality in critically ill elderly patients with infections

Introduction This study aimed to investigate whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU might be associated with adverse clinical outcomes in elderly patients with infections. Material & Method This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results and ED LOS. The outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was analyzed to identify the factors predictive of mortality. Result A total of 439 patients admitted to the ICU via the ED were finally included in this study, of whom 132 (30.1%) died in the hospital. The median (IQR) age was 78 (73, 83) years. In the multivariable analysis, a history of malignancy, lactate level and ED LOS were shown to be independent risk factors for all-cause in-hospital mortality (OR 3.76; 95% CI 1.88-7.52; p 12 hours had a longer hospital LOS (p = 0.018), and those with an ED LOS >24 hours had a longer hospital LOS and higher mortality rate (p = 0.044, p = 0.008). Conclusion This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections visiting the ED.