London, United Kingdom 2013 16 Acute cerebrovascular events (ACE): TIA and minor strokes Effect of Emergency Department overcrowding on ED disposition for transient ischemic at-tack E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 573 and minor stroke patients. M. Ben-Yakov1, M. Kapral2, J. Fang3, L. Shudong4, M.J. Schull5 University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, CANADA1, Institute for Clinical Evaluative Sciences, Toronto, CANADA2, Institute for Clinical Evaluative Sciences, Toronto, CANADA3, Institute for Clinical Evaluative Sciences, Toronto, 4, In-stitute for Clinical Evaluative Sciences, Toronto, CANADA5 TIA and stroke are leading causes of disability and carry important risk of subsequent morbidity. Assessment and risk factor modification can occur in-hospital for high risk patients or in specialized out-patient clinics for lower risk patients, but current risk stratification tools are unreliable. Context factors such as the degree of Emergency Department crowding, may influence the decision to ad-mit or discharge a patient in the absence of validated clinical guidelines. We studied the association between Emergency Department (ED) overcrowding and likelihood of admission to hospital for pa-tients with TIA or minor stroke (defined as Canadian Neurological Score >8) upon first presentation to the ED. A retrospective cohort study from the Registry of the Canadian Stroke Network (12 Ontario EDs from 2003-2008) linked to administrative databases. IRB approval was provided. Descriptive statis-tics and patient-level multivariate logistic regression were used. The main outcome was ED disposi-tion (discharge vs admission). We adjusted for important patient, ED shift and hospital characteris-tics. The main exposure was degree of ED crowding, measured as mean hours of ED Length-of-stay (ED LOS) for patients in the same ED, shift, and Triage severity categories. 9759 patients TIA (47.2%) and minor stroke (52.8%) were included. The discharge rate from ED was 25.5% for stroke and 74.5% for TIA patients. In the overall cohort, increasing levels of crowd-ing were associated with decreased risk of discharge. (Table 1) However, when stratified by ED an-nual volumes increasing ED LOS was associated with statistically significant increased risk of ED discharge in higher volume sites, while the opposite effect was seen in lower volume sites. (Figure 1) ED crowding is associated with increased risk of discharge of TIA and minor stroke patients, but only in higher volume settings. This may reflect the burden of ED crowding in higher volume sites, as well as better access to rapid out-patient specialized follow-up. Given the lack of validated risk stratification tools, ensuring appropriate disposition among high risk patient populations even during crowded conditions seems paramount.
Karger_ESC London_2013
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