Hospital Admission and Survival of Patients With Brain Metastases Diagnosed in the Emergency Care Setting.

Abstract

Brain metastases (BMETS) are commonly diagnosed in emergency care setting (ECS)-such as the emergency department (ED) or after direct admissions-yet research on their admission patterns, management, and survival is limited. This study examines the clinical course, outcomes, and potential impact of an admission algorithm for patients diagnosed with BMETS in ECS. This is a retrospective study conducted across three academic hospitals, analyzing admissions and survival of BMETS patients in ECS. Patients were age at least 18 years with imaging-confirmed BMETS. We developed an admission algorithm that was retrospectively applied to assess the rationale for hospitalization. Primary outcomes included admission rates, length of stay (LOS) in the ED and hospital, and overall survival. Among 312 patients, 250 had brain imaging available at initial ECS presentation; 241 (96.4%) were admitted. Median ED LOS was 7 hours, increasing with multiple imaging studies (<i>P</i> < .001) and consults (<i>P</i> = .01). Median hospital LOS was 6.7 days, prolonged by inpatient interventions (9.9 <i>v</i> 6.2 days, <i>P</i> < .001) and poor functional status (8.6 <i>v</i> 5.4 days, <i>P</i> < .001). Median survival post-discharge was 4.4 months, influenced by functional status (<i>P</i> < .001) and comorbidities (<i>P</i> = .004). Applying the admission algorithm, 224 (89.6%) required hospitalization while 26 (10.4%) were eligible for outpatient care. BMETS patients in ECS have high admission rates and poor survival. A standardized admission algorithm may reduce ED LOS by identifying patients who require hospitalization. Further research is needed to refine triage and improve outcomes.