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Delayed emergency department presentation in critically ill patients.
R M Rodriguez1, M Passanante, M A Phelps
1Department of Emergency Medicine, Highland General Hospital, Oakland, CA, USA.
Critical Care Medicine
|January 22, 2002
Summary
Most critically ill patients delay emergency department visits due to symptom misjudgment. Male gender and prior medical advice were linked to these delays, highlighting a need for public education on serious illness warning signs.
Area of Science:
- Critical care medicine
- Emergency medicine
- Public health
Background:
- Delayed emergency department (ED) presentation is a significant concern for critically ill patients.
- Understanding the factors contributing to these delays is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the frequency and causes of delayed ED presentation in critically ill patients (excluding acute myocardial infarction).
- To evaluate associations between demographic and socioeconomic factors (age, gender, prior medical advice, insurance, education) and delayed presentation.
Main Methods:
- Prospective, descriptive analysis conducted in an urban county hospital's ED and medical intensive care unit (MICU).
- Adult patients admitted to the MICU for non-cardiac, non-stroke emergencies were interviewed within 72 hours of admission.
- Interviews assessed symptom onset-to-ED presentation time and reasons for delay.
Main Results:
- 58% of interviewed patients (n=155) presented to the ED more than 24 hours after symptom onset.
- Primary reasons for delay included underestimation of symptom severity (31%) and expectation of spontaneous resolution (29%).
- Male gender and prior consultation with a healthcare provider were significantly associated with delayed presentation (p=0.036 for each).
Conclusions:
- A significant proportion of critically ill patients experience substantial delays in seeking emergency care.
- Misunderstanding symptom severity and natural disease progression contributes to these delays.
- Public health education targeting symptom recognition for serious illnesses is recommended for patients and their support networks.