Association between prolonged Emergency Department stay and Intensive Care Unit mortality among patients at a tertiary hospital in Ethiopia

Abstract

Background: Prolonged boarding of critically ill patients in the Emergency Department (ED) is common in low-resource settings and may worsen outcomes. We evaluated whether extended ED length of stay (EDLOS) was associated with increased intensive care unit (ICU) and ED mortality at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: We performed a retrospective cohort study of adults admitted from the ED to the ICU during 2023 (n = 110). EDLOS (triage to ICU admission) was categorized into four groups: <24 h, 48-72 h, and >72 h. ICU mortality by EDLOS group was calculated. Multivariable logistic regression was used to identify independent predictors of ICU death, adjusting for age, Charlson comorbidity index (CCI), mechanical ventilation, diagnosis category, coma, and systolic blood pressure <90 mmHg. Results: A total of 74 patients (67.3%) were admitted to the ICU within 24 h, and 36 (32.7%) were boarded >24 h. ICU mortality increased with longer EDLOS: 39.2% (<24 h), 58.8% (48-72 h), and 58.3% (>72 h). After adjustment, EDLOS of 48-72 h was associated with higher odds of ICU death compared with <24 h ((Adjusted Odds Ratio) AOR 3.34; 95% CI 1.22-9.16; p = 0.019), whereas EDLOS >72 h was not statistically significant. Other independent predictors of ICU mortality included ED systolic blood pressure <90 mmHg (AOR ≈ 7.0), respiratory admission diagnosis (AOR ≈ 3.9), and a one-point increase in Charlson comorbidity score (AOR ≈ 1.6). Conclusion: At this tertiary care center, prolonged ED boarding beyond 48 h was associated with substantially higher ICU mortality. Boarded patients had more comorbidities and were hemodynamically unstable. Our findings underscore the urgent need to enhance ICU access, prioritize timely transfers of the sickest patients, and strengthen ED critical care capacity in similar low-resource settings.