ICU transfer delay and mortality after ward-onset shock

To assess whether intensive care unit (ICU) transfer delay after ward-onset shock is associated with mortality, and whether early point-of-care ultrasound (POCUS) is associated with outcomes.

Retrospective cohort study using an ICU registry linked to electronic health records at West China Hospital (Jan 1, 2019-Jan 31, 2024). Adults with ward-onset shock requiring first ICU transfer were included. Transfer delay was grouped as <3 h, 3-6 h, or > 6 h. Multivariable logistic regression adjusted for age, APACHE II, and SOFA. Early POCUS was defined as ultrasound within 6 h of shock onset.

Among 3535 patients, in-hospital mortality was 24.0%. Mortality increased across delay groups: 18.0% (<3 h; n = 2849), 40.7% (3-6 h; n = 150), and 51.5% (>6 h; n = 536). Versus <3 h, adjusted odds of in-hospital death were higher for 3-6 h (OR 2.34, 95% CI 1.62-3.38) and > 6 h (OR 3.27, 95% CI 2.65-4.03) (both P < 0.001). Early POCUS (n = 251, 7.1%) was associated with lower in-hospital mortality (adjusted OR 0.57, 95% CI 0.37-0.84; P = 0.005) and lower 28-day mortality (adjusted OR 0.47, 95% CI 0.30-0.72; P < 0.001).

ICU transfer delay after ward-onset shock was independently associated with increased mortality, whereas early POCUS was associated with lower mortality.