Evaluation of Emergency Department Length of Stay and 30-Day Mortality in Critically Ill Patients

Purpose Emergency department length of stay (EDLOS) is considered a potential quality indicator in the management of critically ill patients. However, the relationship between EDLOS and mortality remains controversial, particularly in patients requiring intensive care unit (ICU) admission. This study aimed to evaluate whether prolonged EDLOS is associated with increased 30-day mortality among patients with ICU indications and to identify other independent predictors of mortality and prolonged EDLOS. Methods In this retrospective observational study, 2,916 patients with ICU admission indications were included. Patients were divided into two groups based on EDLOS < 8 hours and ≥ 8 hours. Multivariate logistic regression was used to assess independent predictors of mortality and prolonged EDLOS. Results The overall 30-day mortality rate was 39.8%. Although univariate analysis showed higher mortality in patients with EDLOS ≥ 8 hours, multivariate analysis revealed that EDLOS was not an independent predictor of mortality. Age, Charlson Comorbidity Index (CCI), and sepsis, pneumonia, renal-metabolic disorders were significantly associated with increased mortality. In addition, prolonged EDLOS was independently associated with nighttime ED presentation, advanced age, and higher CCI scores. Conclusions Prolonged EDLOS was not independently associated with mortality among patients requiring ICU admission. Mortality appeared to be more strongly related to patient-specific clinical factors. Early identification and prioritization of high-risk patients, particularly those with advanced age and high comorbidity burden, are essential to optimize emergency care outcomes.