ICU transfer delay and mortality after ward-onset shock.

Area of Science:

• Critical Care Medicine
• Emergency Medicine
• Diagnostic Imaging

Background:

• Ward-onset shock is a critical condition requiring timely intensive care unit (ICU) admission.
• Delays in ICU transfer can negatively impact patient outcomes.
• Point-of-care ultrasound (POCUS) is an increasingly utilized tool in critical care settings.

Purpose of the Study:

• To investigate the association between intensive care unit (ICU) transfer delay and mortality in patients with ward-onset shock.
• To determine if early point-of-care ultrasound (POCUS) use is associated with improved patient outcomes in this population.

Main Methods:

• Retrospective cohort study of 3535 adult patients with ward-onset shock requiring ICU transfer.
• Analysis of ICU registry and electronic health records from West China Hospital (2019-2024).
• Comparison of mortality rates based on ICU transfer delay (<3h, 3-6h, >6h) and early POCUS use (within 6h of shock onset).

Main Results:

• In-hospital mortality was 24.0%, increasing significantly with transfer delay: 18.0% (<3h), 40.7% (3-6h), and 51.5% (>6h).
• Adjusted odds of in-hospital death were higher for delays of 3-6h (OR 2.34) and >6h (OR 3.27) compared to <3h.
• Early POCUS use (7.1% of patients) was associated with lower in-hospital (aOR 0.57) and 28-day mortality (aOR 0.47).

Conclusions:

• ICU transfer delay following ward-onset shock is an independent predictor of increased mortality.
• Early application of POCUS in patients with ward-onset shock is associated with reduced mortality.
• These findings highlight the importance of timely ICU transfer and the potential benefit of early POCUS in managing ward-onset shock.