Length of Stay as Quality Indicator in Emergency Department in Trauma Patient

Abstract

Background: Severe injuries are a major global cause of morbidity and mortality, particularly in young adults, with emergency department (ED) crowding and prolonged length of stay (LOS) worsening outcomes. ED LOS is a key quality indicator, as delays increase complications and mortality. This study aimed to evaluate the impact of LOS on trauma outcomes and ED performance. Methods: A prospective observational study was conducted at Zagazig University Hospital ED, including 254 adult polytrauma patients equally divided into two groups: Group A (LOS <4 hours, n=127) and Group B (LOS >4 hours, n=127). Inclusion required age ≥18 years, hemodynamic stability, and informed consent, while exclusions were minors, pregnancy, psychiatric illness, medicolegal cases, and need for immediate life-saving intervention. Injury severity was classified by the Abbreviated Injury Scale. Clinical assessment followed ATLS protocols with standard imaging, FAST, and selective CT. Results: Group B patients were older (36.4vs.30.6 years, P=0.0006), with more road traffic accidents (86.6%vs.66.9%), while falls predominated in Group A (33.1%vs.13.4%, P=0.0002). Group A had higher rates of pneumothorax (10.2%vs.3.2%), lung contusions (15.0%vs.0%), and splenic hematoma (3.2%vs.0%), whereas Group B showed more brain edema (16.5%vs.4.7%), contusions (21.3%vs.11.8%), vertebral (7.9%vs.0%) and limb fractures (31.5%vs.15.0%). ICU transfers were higher in Group B (51.2%vs.37.0%), but mortality was similar (24.4%vs.21.3%, P=0.5517). Conclusion: Shorter LOS improved workflow and manager satisfaction without increasing mortality, while longer LOS reflected more complex injuries requiring ICU care and was associated with higher patient satisfaction. LOS is a reliable quality indicator to guide triage and resource allocation in trauma care.