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The following is a summary of “Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study,” published in the August 2024 issue of Critical Care by Herwerden et al.

Researchers conducted a retrospective study to assess the significance of emergency department (ED) to ICU time on hospital mortality, dividing patients by academic and nonacademic teaching (NACT) hospitals and taking into account Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores.

They used data from the Dutch National Intensive Care Evaluation registry. Patients from ED to ICU were included from 4 academic and 8 NACT hospitals. Odds ratios (ORs) for mortality linked to ED-to-ICU time were estimated by multivariable regression, both in crude form and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores.

The results showed a median ED-to-ICU time of 1.9 hours (interquartile range, 1.2–3.1 hr). There was no overall association between ED-to-ICU time and hospital mortality after probability adjustment for APACHE-IV(P= 0.36). Patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours, the adjusted OR (ORs_adjApache) was 1.24 (95% CI, 1.00–1.54; P< 0.05) as compared to the reference category (< 1.1 hr). In the academic hospitals, the ORs_adjApache) for ED-to-ICU times of 1.6–2.3, 2.3–3.4, and greater than 3.4 hours were 1.21 (1.01–1.46), 1.21 (1.00–1.46), and 1.34 (1.10–1.64), respectively. In NACT hospitals, no association was observed (P= 0.07). Subsequently, ORs were adjusted for ED-triage score (ORs_adjED). In the academic hospitals, the ORs_adjED for ED-to-ICU times more significant than 3.4 hours was 0.98 (0.81 — 1.19), and no overall association was observed (P=0.08). In NACT hospitals, all time-ascending quintiles had ORs_adjED) values of less than 1.0 (P< 0.01). 

They concluded that prolonged ED-to-ICU time was linked with increased hospital mortality rate in patients with the highest APACHE-IV probability at academic hospitals. No significant unfavorable association was found in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality after adjustment and stratification for ED-triage score was not found. 

Source: journals.lww.com/ccmjournal/fulltext/9900/emergency_department_triage,_transfer_times,_and.364.aspx