Neurological outcomes in critically ill patients after emergency department admission: A prospective cohort study

Abstract

Introduction: Survival alone may not fully reflect the quality of emergency and critical care. Neurological outcomes provide an important measure of recovery among critically ill patients treated in the emergency department (ED). Objective: To identify patient- and emergency care system-related factors associated with neurological outcomes following ED admission. Methods: This prospective cohort study was conducted across seven tertiary hospitals in six central provinces of Thailand between December 2023 and May 2024. Critically ill adult patients (≥18 years) admitted to the ED were enrolled. A favorable neurological outcome was defined as a Cerebral Performance Category (CPC) score of 1 or 2. Data were analyzed using a population-averaged Generalized Estimating Equation (GEE) model to account for repeated outcome measurements. Results: Among 442 critically ill adult patients admitted to the ED, the mean age was 66.8 ± 15.0 years, 230 (52.0%) were female, and 254 (57.7%) were classified as Emergency Severity Index (ESI) level 2. At 30 days, 393 patients (96.4%) achieved favorable neurological outcomes. Increasing age (OR 0.95; 95% CI: 0.92–0.97), and a high risk of pre-cardiac arrest signs (OR 0.15; 95% CI 0.03–0.83) were associated with lower odds of favorable neurological outcomes. In contrast, higher emergency nursing competency (OR 2.78; 95% CI: 1.11–6.96) and adherence to clinical practice guidelines for early warning signs monitoring patients' status (OR 2.76; 95% CI: 1.10–6.94) were independently associated with higher odds of favorable neurological outcomes. Conclusion: Both patient characteristics and emergency care system factors were associated with neurological outcomes following ED admission. Enhancing emergency nursing competency and adherence to clinical practice guidelines may improve neurological recovery among critically ill patients.