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Sheikh Hassan M, Osman Sidow N, Gökgül A, Ali Adam B, Farah Osman M, Hassan Mohamed H, Gedi Ibrahim I, Ahmed Abdi I. Pattern of Neurological Disorders among Patients Evaluated in the Emergency Department; Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 11:e20. [PMID: 36743701 PMCID: PMC9887228 DOI: 10.22037/aaem.v11i1.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Neurologic disorders are common reasons for emergency consultations. Most neurologic disorders seen in the emergency department (ED) are life-threatening and require urgent treatment. The goal of this study is to investigate the pattern of neurological disorders among patients evaluated in the ED. Methods This is a cross-sectional study conducted in the ED of Mogadishu Somali Turkish Training and Research Hospital, from July 2021 to February 2022. The clinical and epidemiological characteristics of adult patients with neurologic manifestations in the ED were evaluated. Age, gender, distribution of neurological disease manifestations, neurological examination findings, and neurological diagnoses made by consultant neurologists were assessed. Results During the study period, 321 patients were assessed (3.7 % of all ED admissions). The majority of the patients in the study were above 50 years of age (62.6% male). Hypertension was the most common comorbidity among these patients with 122 (38%) cases, followed by diabetes mellitus with 65 (20.2%), and heart diseases with 26 (8.1%) cases. The main reasons for neurology consultations were altered mental status with 141 (44%) cases, motor weakness with 102 (31.8%), seizures with 33 (10%), headache with 17 (5.3%), and vertigo with 9 (2.8%) cases. 196 (61%) had hemiplegia, 60 (18.7%) had consciousness impairment, and 38 (11.8%) had normal neurological examination. The most frequent neurological diagnoses were ischemic strokes with 125 (39%) cases, hemorrhagic strokes with 65 (20.2%), epileptic seizures with 28 (8.7%), and metabolic encephalopathies with 13 (4%) cases. The median duration of the neurology consultations was 20 minutes. 251 (78%) of the patients were admitted to the hospital, while 70 (22%) were discharged from the emergency department. After neurology consultation, the neurology department made the most admissions with 226 (90%) cases, while 25 (10%) were admitted by other departments. Of those admitted, 186 (74.2%) were admitted to the neurology ward, and 65 (25.8%) were admitted to the intensive care unit. Conclusion In our study, neurologic emergencies accounted for 3.7% of all emergency admissions. Stroke, epileptic seizures, cerebral venous thrombosis, encephalopathies, and acute spinal cord diseases were the most common neurological disorders. The admission rate was very high following neurologic assessment by neurologists.
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Affiliation(s)
- Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia. ,Corresponding Author: Mohamed Sheikh Hassan; Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia. Tel: +252615609080, , ORCID: 000-0001-7236-1524
| | - Nor Osman Sidow
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Alper Gökgül
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Bakar Ali Adam
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Farah Osman
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Hussein Hassan Mohamed
- Department of Emergency Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ismail Gedi Ibrahim
- Department of Radiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ishak Ahmed Abdi
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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Togher Z, Fullam S, Callanan I, Kearney H, Tubridy N. An evaluation of optimal tutorial methodologies for neurology teaching at undergraduate level : Optimal tutorial methods for neurology. Ir J Med Sci 2020; 190:965-969. [PMID: 33078263 DOI: 10.1007/s11845-020-02411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
AIM We aim to determine the efficacy of an intensive week of large group tutorials in the teaching of neurology to medical students. We also look to compare teaching methods within our centre. METHODS Students were asked to complete a questionnaire before and after large group tutorials ranking their confidence in neurology. Students from two consecutive years were studied, each using a different tutorial method. An 'intensive week' approach was then compared to a 'once a week' approach. RESULTS Responses from pre and post the tutorial week were compared. Students reported an improvement in all domains following either method of delivering tutorials. There was no statistically significant difference between the two approaches. CONCLUSION Large group tutorials are an effective way of delivering neurology teaching to undergraduate medical students.
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Affiliation(s)
- Zara Togher
- Departments of Neurology, St Vincent's University Hospital, Dublin, Ireland.
| | - Sarah Fullam
- Departments of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Ian Callanan
- Departments of Clinical Audit, St Vincent's University Hospital, Dublin, Ireland
| | - Hugh Kearney
- Departments of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Tubridy
- Departments of Neurology, St Vincent's University Hospital, Dublin, Ireland
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Abstract
Liaison neurology (consulting with inpatient ward referrals) is the main way that most patients admitted with neurological disease will access neurology services. Most liaison neurology services are responsive, seeing referrals on request, but they also can be proactive, with a regular neurology presence in the acute medical unit. Fewer than half of hospitals in England have electronic systems, yet these can facilitate the process-allowing electronic responses to advise on investigations before seeing the patient, and arranging follow-up after-as well as prioritising referrals and documenting the process. In this time of COVID-19, there are additional benefits in providing prompt remote advice. Improving the way liaison neurology is delivered can improve patient outcomes and save money by shortening admissions. This hidden work of the neurologists needs to be recorded and recognised.
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Affiliation(s)
- Geraint N Fuller
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK .,Getting It Right First Time, Royal National Orthopaedic Hospital, Middlesex, UK
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The urgent neurological consultation in the population of the province of Ferrara, Italy. Neurol Sci 2018; 39:1253-1259. [DOI: 10.1007/s10072-018-3424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
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Bacellar A, Pedreira BB, Costa G, Assis T. Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study. BMC Health Serv Res 2017; 17:504. [PMID: 28738866 PMCID: PMC5523147 DOI: 10.1186/s12913-017-2260-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/24/2017] [Indexed: 01/19/2023] Open
Abstract
Background The burden of neurological disorders (NDs) in older adult inpatients is often underestimated. We studied diagnostic frequency and comorbidity of NDs among inpatients aged ≥60 years. We compared rates of hospital mortality, length of stay (LOS), and readmission with younger patient counterparts (aged 18–59 years) and older adult non-neurological patients. Methods This was a retrospective cross-sectional study of inpatients in a tertiary care center in Brazil. We compiled data for all patients admitted between 1 January 2009 and 31 December 2010, and selected those aged ≥18 years for inclusion in the study. We collected data for inpatients under care of a clinical neurologist who were discharged with primary diagnoses of NDs or underlying acute clinical disorders, and data for complications in clinical or surgical inpatients. Patients who remained hospitalized for more than 9 days were categorized as having long LOS. Results Older adult inpatients with NDs (n = 798) represented 56% of all neurological inpatients aged ≥18 years (n = 1430), and 14% of all geriatric inpatients (n = 5587). The mean age of older adult inpatients was 75 ± 9.1 years. Women represented 55% of participants. The most common NDs were cerebrovascular diseases (51%), although multimorbidity was observed. Hospital mortality rate was 18% (95% confidence interval [CI], 15–21) and readmission rate was 31% (95% CI, 28–35), with 40% of patients readmitted 1.8 ± 1.5 times. The long LOS rate was 51% and the median LOS was 9 days (interquartile interval, 1–20 days). In younger inpatients mortality rate was 1.4%, readmission rate was 34%, and long LOS rate was 14%. In older adult non-neurological inpatients, mortality rate was 22%, readmission rate was 49%, and long LOS rate was 30%. Conclusions Older adult neurological inpatients had the highest long LOS rate of all patient groups, and a higher mortality rate than neurological patients aged 18–59 years. Readmissions were high in all groups studied, particularly among older adult non-neurological inpatients. Improved structures and concerted efforts are required in hospitals in Brazil to reduce burden of NDs in older adult patients.
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Affiliation(s)
- Aroldo Bacellar
- Department of Neurology, Hospital São Rafael, Av. São Rafael 2152, São Marcos, Salvador, BA, CEP 41235-190, Brazil.
| | - Bruno B Pedreira
- Department of Neurology, Hospital São Rafael, Av. São Rafael 2152, São Marcos, Salvador, BA, CEP 41235-190, Brazil
| | - Gersonita Costa
- Department of Neurology, Hospital São Rafael, Av. São Rafael 2152, São Marcos, Salvador, BA, CEP 41235-190, Brazil
| | - Telma Assis
- Department of Neurology, Hospital São Rafael, Av. São Rafael 2152, São Marcos, Salvador, BA, CEP 41235-190, Brazil
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Umesh A, Gowda GS, Kumar CN, Srinivas D, Dawn BR, Botta R, Yadav R, Math SB. Unknown Patients and Neurology Casualty Services in an Indian Metropolitan City: A Decades Experience. Ann Indian Acad Neurol 2017; 20:109-115. [PMID: 28615894 PMCID: PMC5470161 DOI: 10.4103/0972-2327.205764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of "unknown" patients. MATERIALS AND METHODS We did retrospective chart review of all "Unknown" patients from January 2002 to December 2011, who was admitted under Neurology Emergency Service at a Tertiary Care Neuropsychiatry Center in South Indian Metropolitan City. Clinical and sociodemographic characteristics and clinical outcome of the sample were analyzed. RESULTS A total of 151 unknown patients were admitted during the 10 years. Out of these, 134 (88.7%) were males with the mean age of 43.8 ± 14.8 years and 95 (63%) were aged >40 years. Among them, 147 (97.4%) were from the urban vicinity, 126 (83.6%) were brought by police and 75 (49.7%) were registered as medico-legal cases. Out of these, only 3 (2%) patients had normal sensorium, whereas 101 (66.9%) presented with loss of consciousness. Forty-one (27.2%) unknown patients had a seizure disorder, 37 (24.5%) had metabolic encephalopathy, 26 (17.2%) had a stroke, 9 (6%) had neuro-infection, and 17 (11.3%) had a head injury. Deranged liver functions were seen in 65 (43%), renal derangement in 37 (24.5%), dyselectrolytemia in 42 (27.8%), and abnormal brain imaging finding in 95 (62.9%) patients. Furthermore, there were 14 (9.3%) deaths. CONCLUSIONS Our findings demonstrate seizures, metabolic causes, and neuro-infections were the primary reasons for admission of unknown patients to neuro-emergency service. This novel Indian study data show the common causes of admission of unknown patients in neurology. This pattern can be useful to guide the approach of healthcare providers in India.
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Affiliation(s)
- Achary Umesh
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Bharath Rose Dawn
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ragasudha Botta
- Department of Clinical Neuroscience, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Liu CY, Chiang HL, Fu SC, Su YC, Hsiao CL, Yang FY, Lin SK. Common Neurological Disorders Involving Inpatient Liaisons at a Secondary Referral Hospital in Taiwan: A Retrospective Cross-Sectional Study. J Clin Neurol 2016; 12:93-100. [PMID: 26754782 PMCID: PMC4712292 DOI: 10.3988/jcn.2016.12.1.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 12/01/2022] Open
Abstract
Background and Purpose The requirement for neurology liaison is increasing in accordance with the growing health care demands associated with aging populations. The aim of this study was to characterize the nature of neurological inpatient liaisons (NILs) to help plan for the appropriate use of neurology resources. Methods This was a retrospective cross-sectional study of NILs in a secondary referral hospital over a 12-month period. Results There were 853 neurological consultations with a liaison rate of 3% per admission case. Chest medicine, gastroenterology, and infectious disease were the three most frequent specialties requesting liaison, and altered consciousness, seizure, and stroke were the three most frequent disorders for which a NIL was requested. Infection was the most common cause of altered consciousness. Epilepsy, infection, and previous stroke were common causes of seizure disorders. Acute stroke accounted for 44% of all stroke disorders. Electroencephalography was the most recommended study, and was also the most frequently performed. Ninety-five percent of emergency consultations were completed within 2 hours, and 85% of regular consultations were completed within 24 hours. The consult-to-visit times for emergency and regular consultations were 44±47 minutes (mean±standard deviation) and 730±768 minutes, respectively, and were shorter for regular consultations at intensive care units (p=0.0151) and for seizure and stroke disorders (p=0.0032). Conclusions Altered consciousness, seizure, and stroke were the most common reasons for NILs. Half of the patients had acute neurological diseases warranting immediate diagnosis and treatment by the consulting neurologists. Balancing increasing neurologist workloads and appropriate health-care resources remains a challenge.
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Affiliation(s)
- Chih Yang Liu
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Han Lin Chiang
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Ser Chen Fu
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Yu Chin Su
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Cheng Lun Hsiao
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Fu Yi Yang
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Shinn Kuang Lin
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Coban E, Mutluay B, Sen A, Keskek A, Atakl D, Soysal A. Characteristics, diagnosis and outcome of patients referred to a specialized neurology emergency clinic: prospective observational study. Ann Saudi Med 2016; 36:51-6. [PMID: 26922688 PMCID: PMC6074276 DOI: 10.5144/0256-4947.2016.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Organization and management of neurological emergencies differs among hospitals. Some have specialized neurological emergency rooms (ER). OBJECTIVES The purpose of this study was to determine the characteristics, diagnosis and outcome of patients referred to a specialized emergency neurology clinic. DESIGN Prospective, observational study of consecutive patients presenting between March 2014 and July 2014. SETTING Neurologicaler of a training and research neuropsychiatric hospital. PATIENTS AND METHODS Patients older than 16 years of age with a neurological complaint were assessed by neurological exam, laboratory and imaging tests including brain computed tomography (CT), brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis, electroencephalography or electromyography. MAIN OUTCOME MEASURES Types of diagnosis. RESULTS Of 4500 patients, 2602 (57.8%) were female, and the mean age was 49.2 (23.6) years. The most common symptom was headache, which presented in 30.8% of all patients. The three most common diagnoses after emergency work-up were headache (27.8%), stroke (20.6%) and peripheral vertigo (13%). In the ER, CT was performed on 65.5% of patients and MRI on 66.9%. After emergency work-up, 72.2% patients were discharged home. CONCLUSIONS Neurological diseases are common, with headache and cerebrovascular diseases being the most frequent diagnosis in this specialized ER. CT and MRI are most often used to diagnose or exclude neurological diseases. Many patients do not require immediate hospitalization. The two most frequent diagnoses for hospitalization were stroke and demyelinating disease. LIMITATIONS Absence of follow up data on patients discharged home.
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Affiliation(s)
- Eda Coban
- Mrs. Eda Coban, Bakirkoy Education and Training Hospital of Neurology,, Neurosurgery and Psychiatry,, Istanbul, Turkey, M: 0505 483 43 77,
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Mapoure Y, Ongono J, Nkouonlack C, Beyiha G, Mouelle A, Luma H. Neurological disorders in the emergency centre of the Douala General Hospital, Cameroon: A cross-sectional study. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Should we call the neurologist? The value and cost of a growing neurology consultation service. Ir J Med Sci 2015; 185:611-616. [DOI: 10.1007/s11845-015-1317-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/23/2015] [Indexed: 11/30/2022]
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Morrison I, Jamdar R, Shah P, Fisher M, Leach JP. Neurology liaison services in the acute medical receiving unit. Scott Med J 2014; 58:234-6. [PMID: 24215043 DOI: 10.1177/0036933013507872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Guidelines from the Association of British Neurologists and National Health Service Quality Improvement Scotland suggest that neurologists should be involved in the early management of patients presenting to hospital with acute neurological illness. AIM We chose to evaluate whether regular neurology review in an acute medical receiving unit in a busy city hospital was feasible, and whether it would have an impact on patient care. METHODS Over a 5-week period from Monday to Friday, all neurology patients admitted to an acute medical receiving unit were identified and all headaches and blackouts were reviewed. RESULTS Fourteen (24%) were headache patients, 37 (63%) presumed seizure and 8 (13%) had another neurological illness. Diagnosis was made by the admitting physician in six headache patients (43%). The remaining eight headache patients were diagnosed by the visiting neurologist and two physician diagnoses were revised. The diagnosis made by the admitting physician was clarified by the visiting neurologist in 13 blackout patients (35%) and nine other diagnoses were revised (24%). Appropriate outpatient follow-up or transfer was arranged. CONCLUSION These results suggest that a daily neurology review service is useful in medical receiving units by clarifying diagnoses, directing tests and limiting inappropriate follow-up.
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Affiliation(s)
- I Morrison
- ST6 Neurology, Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
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Need for neurology specialists to be dedicated to hospital care in Italy. Neurol Sci 2013; 34:2193-8. [PMID: 23619531 DOI: 10.1007/s10072-013-1446-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
Any patients admitted to healthcare facilities with a neurological diseases deserves to be managed by a neurologist. This is particularly important for acute onset neurological disorders, because of their severity and the requirement of early and appropriate diagnostic-therapeutic approach. In addition, this may reduce both unnecessary admissions and length of stay, with a significant saving of resources for the National Health System (NHS). To ensure this, it is important to evaluate predictable needs for hospital neurologists in Italy. The hospital discharges for neurological medical diseases of the Major Disease Category (MDC) 1 were 455,132 in 2009 and 491,836 in 2008, more than 50 % of which were acute neurological disorders. Stroke and transient ischemic attacks (TIA) accounted for about 170,000 per year. Currently available neurologists in Italian healthcare facilities are largely insufficient to assist such a large number of patients. The 270 Neurological Care Units in Italy (of which 243 open to the emergency care) are equipped with an average number of 7.7 neurologists per unit, inadequate to ensure on duty care 24 h a day, 7 days a week. In addition, the mean age of hospital neurologists is quite high, with provision for large retirement. It is therefore required to increase in the next few years the number of neurologists by at least 30 %, with an increase of 562 units. To meet the need for neurology specialists committed to hospital care in Italy is also necessary to increase the number of scholarships for residents in post-graduate schools.
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Lange MC, Braatz VL, Tomiyoshi C, Nóvak FM, Fernandes AF, Zamproni LN, Piovesan EJ, Nóvak EM, Teive HAG, Werneck LC. Neurological diagnoses in the emergency room: differences between younger and older patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:212-6. [PMID: 21537563 DOI: 10.1590/s0004-282x2011000200014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/24/2010] [Indexed: 11/22/2022]
Abstract
UNLABELLED Neurological diseases are prevalent in the emergency room (ER). The aim of this study was to compare the neurological diagnoses between younger and older patients evaluated in the ER of a tertiary care hospital. METHOD Patients admitted to the ER who required neurological evaluation in the first 24 hours were separated into two groups based on age, ≤50 years old and >50 years old. RESULTS Cerebrovascular disease (59.6% vs. 21.8%, p<0.01) was most frequent in the >50 years old group. Seizures (8.1% vs. 18.6%, p<0.01) and primary headache (3.7% vs. 11.4%, p<0.01) were most frequent in the ≤50 years old group. CONCLUSION The current study demonstrated that these three neurological diagnoses represented the majority of the neurological evaluations in the ER. National guidelines for ER teams that treat these prevalent disorders must be included in clinical practice and training.
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Affiliation(s)
- Marcos C Lange
- Neurology Division, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Douglas MR, Peake D, Sturman SG, Sivaguru A, Clarke CE, Nicholl DJ. The inpatient neurology consultation service: value and cost. Clin Med (Lond) 2011; 11:215-7. [PMID: 21902069 PMCID: PMC4953309 DOI: 10.7861/clinmedicine.11-3-215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neurological conditions comprise a significant proportion of patient admissions to hospital but, in the majority of cases, are admitted under the care of non-neurological physicians. As a consequence, neurological ward consultations are commonly requested by the admitting medical teams to review diagnoses and management plans. The outcomes of neurological ward consultations were examined and the time required for the referral process recorded by performing a detailed prospective three-month audit of inpatient referrals to the neurology service. The consultations of 120 patients were recorded, categorised and analysed. These consultations were beneficial in the vast majority of cases, with a clear impact on patient diagnoses or management plans. The consultation process was time consuming, however, both in respect of the initial review, but also with follow-up visits. This audit highlights the importance of neurological input in the diagnosis and management of hospital inpatients. The time taken for this process should be resourced appropriately.
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Affiliation(s)
- M R Douglas
- Department of Neurology, Russells Hall Hospital, Dudley Group of Hospitals NHS Trust, Dudley.
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Rudolf J, Dermitzakis EV, Kyriazopoulou E, Nikiforidou D, Gravas I, Papadopoulos V, Tsiptsios I. Workload of the emergency room neurologists and the neurological inpatient department in a Greek tertiary care hospital. Clin Neurol Neurosurg 2010; 112:332-5. [DOI: 10.1016/j.clineuro.2009.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 11/08/2009] [Accepted: 11/30/2009] [Indexed: 11/28/2022]
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Urgent neurology consultation from the ED for transient ischemic attack. Am J Emerg Med 2010; 29:601-8. [PMID: 20825839 DOI: 10.1016/j.ajem.2009.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/17/2009] [Accepted: 12/29/2009] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the association between urgent neurology consultation and outcomes for patients with transient ischemic attack (TIA). METHODS In a secondary analysis of data from 1707 emergency department patients with transient ischemic attack from March 1997 to May 1998, we compared presentation, management, and outcomes by neurology consultation status using generalized estimating equations to adjust for ABCD(2) score and clustering by facility and survival analysis for outcomes. RESULTS Consultation was obtained f28% of patients. Median ABCD(2) scores were comparable, but consultation was associated with hospital admission (odds ratio, 1.35 [1.02-1.78], P = .04) and use of antithrombotics (odds ratio, 1.88 [1.20-2.93], P = .005). The cumulative stroke risk was significantly lower within 1 week (5.3% versus 7.5%, P = .02) but not at 90 days (9.9% versus 11.0%, P = .21). CONCLUSIONS Consultation was not targeted to high-risk patients but was associated with some quality of care measures and improved early outcomes; however, improvement in 90-day outcomes was not established.
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Petheram KRC. Neurology on the acute take. Clin Med (Lond) 2010; 10:148-50. [PMID: 20437986 PMCID: PMC4952087 DOI: 10.7861/clinmedicine.10-2-148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The neurologist in the emergency department. An Italian nationwide epidemiological survey. Neurol Sci 2008; 29:67-75. [PMID: 18483703 DOI: 10.1007/s10072-008-0864-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
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Mert E, Özge A, Taşdelen B, Yılmaz A, Bilgin NG. What clues are available for differential diagnosis of headaches in emergency settings? J Headache Pain 2008; 9:89-97. [PMID: 18250963 PMCID: PMC3476189 DOI: 10.1007/s10194-008-0015-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 01/08/2008] [Accepted: 01/09/2008] [Indexed: 11/25/2022] Open
Abstract
The correct diagnosis of headache disorders in an emergency room is important for developing early management strategies and determining optimal emergency room activities. This prospective clinical based study was performed in order to determine demographic and clinical clues for differential diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the emergency room practitioners. This study included 174 patients older than 15 years of age presenting in the emergency room with a chief complaint of headache. Definite headache diagnoses were made according to ICHD-II criteria. Classification and regression tree was used as new method for the statistical analysis of the differential diagnostic process. Our 174 patients with headache were diagnosed as basically primary (72.9%) and secondary (27.1%) headaches. Univariate analysis with cross tabs showed three important results. First, unilateral pain location caused 1.431-fold increase in the primary headache risk (p = 0.006). Second, having any triggers caused 1.440-fold increase in the primary headache risk (p = 0.001). Third, having associated co-morbid medical disorders caused 4.643-fold increase in the secondary headache risk (p < 0.001). It was concluded that the presence of comorbidity, the patient's age, the existence of trigger and relaxing factors, the pain in other body parts that accompanies headache and the quality of pain in terms of location and duration were all important clues for physicians in making an accurate differentiation between primary and secondary headaches.
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Affiliation(s)
- Ertan Mert
- Mersin University School of Medicine, Mersin, Turkey
| | - Aynur Özge
- Mersin University School of Medicine, Mersin, Turkey
- Mersin Üniversitesi Tıp Fakültesi Nöroloji AD, Mersin, Turkey
| | | | - Arda Yılmaz
- Mersin University School of Medicine, Mersin, Turkey
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Rodriguez GJ, Nasar A, Suri MFK, Ezzeddine MA, Qureshi AI. Neuroimaging in Stroke and Seizure As Neurological Emergencies (NISSAN) Study. J Neuroimaging 2008; 18:9-14. [DOI: 10.1111/j.1552-6569.2007.00161.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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