Relationship between emergency department crowding and delay in acute stroke management: A prospective observational study

Objective: Patients with acute stroke should be treated promptly using fast-track management to decrease morbidity and mortality; however, emergency department [ED] crowding may delay treatment. The authors ascertained the efficiency of acute stroke fast-track management by measuring the correlation between ED crowding (occupancy rate) and time from door to computed tomography [CT] scan. Materials and Methods: The present report was a prospective observational study including patients with acute stroke symptoms within 4.5 hours after onset, whom were treated by following the acute stroke fast-track management. The occupancy rate was used to represent ED crowding. The correlation between occupancy rate and timing for each step (time to neurologist/radiologist notification, CT scan, blood laboratory report, or needle) was analyzed using Spearman’s correlation coefficients. Results: Among the 94 patients studied, the medians of the door to CT scan, door to blood laboratory report, and door to fibrinolytic drug administration times were 22 minutes (16 to 27.25), 73.5 minutes (63 to 89.25), and 75 minutes (57.5 to 89.5), respectively. The median occupancy rate was 70% (50 to 100). There was no significant correlation between occupancy rate and door to CT scan time (r = 0.184, p = 0.076) or door to fibrinolytic drug administration (r = 0.272, p = 0.233). However, there was a significant, weak positive correlation between ED crowding and door to blood laboratory report time (r = 0.400, p<0.001). Conclusion: ED crowding was not correlated with door to CT scan time. However, it was correlated with time to blood laboratory report, which might affect acute stroke management.