Effect of a delayed admission to the intensive care unit on survival after emergency department visit in patients with cancer: a retrospective observational study.

BACKGROUND AND IMPORTANCE: Delayed admission to the ICU is reported to be associated with worse outcomes in cancer patients. OBJECTIVE: The main objective of this study was to compare the 180-day survival of cancer patients whether they were directly admitted to the ICU from the emergency department (ED) or secondarily from the wards after the ED visit. DESIGN, SETTINGS AND PARTICIPANTS: This was a retrospective observational study including all adult cancer patients that visited the ED in 2018 and that were admitted to the ICU at some point within 7 days from the ED visit. EXPOSURE: Delayed ICU admission. OUTCOME MEASURE AND ANALYSIS: Survival at day 180 was plotted using Kaplan-Meier curves, and hazard ratio (HR) from Cox proportional-hazard models was used to quantify the association between admission modality (directly from the ED or later from wards) and survival at day 180, after adjustment to baseline characteristics. RESULTS: During the study period, 4560 patients were admitted to the hospital following an ED visit, among whom 136 (3%) patients had cancer and were admitted to the ICU, either directly from the ED in 101 (74%) cases or secondarily from the wards in 35 (26%) cases. Patients admitted to the ICU from the ED had a better 180-day survival than those admitted secondarily from wards (log-rank P = 0.006). After adjustment to disease status (remission or uncontrolled malignancy), survival at day 180 was significantly improved in the case of admission to the ICU directly from the ED with an adjusted HR of 0.50 (95% confidence interval, 0.26-0.95), P = 0.03. CONCLUSION: In ED patients with cancer, a direct admission to the ICU was associated with better 180-day survival compared with patients with a delayed ICU admission secondary from the wards. However, several confounders were not taken into account, which limits the validity of this result.