TOPLINE:

A meta-analysis of more than 400,000 critically ill US patients found that boarding in emergency departments (EDs) was not associated with a significant increase in mortality and hospital length of stay compared with nonboarding.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 17 studies published between 2012 and December 2024, comprising 407,178 critically ill adults admitted to US EDs. Among these, 87.4% were treated in urban academic EDs with resuscitation units.
• Studies compared outcomes between patients boarded in the ED (median age, 48 years) after the admission decision and those promptly transferred to inpatient or ICU settings (median age, 49 years).
• Study populations included patients with trauma (29.4%), medical conditions (29.4%), or mixed critical illness (41.2%).
• The primary outcome was all-cause mortality, and the secondary outcome was hospital length of stay.

TAKEAWAY:

• Patients who were boarded in EDs had similar all-cause mortality (odds ratio [OR], 1.06; P = .383) and hospital length of stay (mean difference, 0.38 days; P =.51) as those not boarded in EDs.
• Among patients who were boarded in EDs, mixed populations of critically ill patients had higher mortality (OR, 1.2; P = .02) and longer hospital length of stay (OR, 1.9; P = .001).
• Additionally, within the boarded group, those with higher Charlson Comorbidity Index scores had a higher risk for mortality and longer hospital length of stay.

IN PRACTICE:

"Critically ill patients boarding in the US Emergency Departments were associated with a non-statistically significant increase in odds of mortality and hospital length of stay compared to nonboarded patients," the authors wrote.

SOURCE:

The study was led by Natalie N. Htet, MD, MS, Division of Critical Care, Stanford Health Care, Palo Alto, California. It was published online on October 17, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

The study was limited by high heterogeneity across included studies. Meta-regression analysis of continuous variables, including physiologic scores and laboratory values, could not be performed due to limited data availability. The exclusion of patients who were downgraded from initial ICU status may have led to selection bias and mortality overestimation.

DISCLOSURES:

The study did not receive any funding. The lead author received a scholarship from the Emergency Medicine Section for presenting an abstract related to this paper at the Society of Critical Care Medicine Congress in 2025. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.