Does Extended Emergency Department Length of Stay (EDLOS) Affect Mortality in Patients with Traumatic Intraperitoneal Hemorrhage needing Emergency Laparotomy?

Kim, Ik Bum; Song, Hwa Sik; Song, In Han

Abstract

PURPOSE: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department.
METHODS
ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors.
RESULTS
One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7+/-100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy.
CONCLUSION
The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.