• Michael C van Herwerden, Carline N L Groenland, Fabian Termorshuizen, Wim J R Rietdijk, Fredrike Blokzijl, Berry I Cleffken, Tom Dormans, Jelle L Epker, Lida Feyz, Niels Gritters van den Oever, Pim van der Heiden, Evert de Jonge, Gideon H P Latten, Ralph V Pruijsten, Özcan Sir, Peter E Spronk, Wytze J Vermeijden, Peter van Vliet, Nicolette F de Keizer, and Corstiaan A den Uil.
• Department of Intensive Care Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
• Crit. Care Med. 2024 Dec 1; 52 (12): 185618651856-1865.

ObjectivesThis study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores.Design, Setting, And PatientsWe conducted a retrospective cohort study (2009-2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores.InterventionsNone.Measurements And Main ResultsA total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2-3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability ( p = 0.36). For 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 with 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 greater than 3.4 hours was 0.98 (0.81-1.19), 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).ConclusionsIn patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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