• Naveed Akhtar, Saadat Kamran, Rajvir Singh, Peter Cameron, Paula Bourke, Rabia Khan, Sujatha Joseph, Mark Santos, Dirk Deleu, Ahmed Own, Wafa Al-Yazeedi, Adeel Ajwad Butt, John Boulton, and Ashfaq Shuaib.
• The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
• J Stroke Cerebrovasc Dis. 2016 Mar 1; 25 (3): 672-8.

Background And AimFollowing an acute stroke (AS), patients are at an increased risk of developing complications that may affect prognosis. With overcrowding in the emergency department (ED), patients stay longer hours to days before transfer to a proper stroke ward. The aim of this study was to evaluate the effect of increasing length of stay (LOS) in the ED on the risk of stroke-related complications.MethodsWe analyzed data from our stroke registry of patients admitted with AS during 2014. Stay in ED was divided into 2 groups: less than 8 hours and more than 8 hours. Data regarding demographics, stroke type, severity of stroke, ED (LOS) in hours, total LOS in hospital, number and types of complications, and prognosis were collected.ResultsMean age was 54.8 years and 78.9% were males (total n = 894). Prior to ward admission, 265 (29.5%) patients remained in the ED for less than 8 hours and 629 (70.4%) remained for more than 8 hours. There was no significant difference in comorbidities or the severity of stroke at admission between the 2 groups. An ED LOS of less than 8 hours was associated with reduced risk of complications (14.3% versus 19.2%, P = .06), reduced LOS in hospital, better prognosis at discharge (72.5% versus 57.6% had modified Rankin Scale of ≤2, P = .001) and at 90 days (89% versus 78.8%, P = .007) and lower in-hospital mortality (1.5% versus 5.4 %, P = .004).ConclusionDelays in transferring AS patients from the ED may lead to an increase in complications resulting in an increased LOS and slower recovery.Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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