Analysis of the neurology consultations in the emergency department and diagnostic accuracy of emergency physicians for the neurologic emergencies
Analysis of the neurology consultations in the emergency department and diagnostic accuracy of emergency physicians for the neurologic emergencies
Aim: The aims of this study are twofold: Firstly, it aims at determining the profile of patients who are requested to consult neurologyin the emergency department. Secondly, it aims at evaluating the concordance between the pre-consultation neurologic diagnosesand the post-consultation diagnoses in the emergency department.Material and Methods: The study presents a retrospective evaluation of the records of the patients who were admitted to the emergencydepartment and requested neurology consultation between July 1st, 2018 and July 1st, 2019. Demographic characteristics, admissiontypes, diagnostic imaging procedures, requested consultations, pre-consultation diagnoses, duration of neurology consultation,post-consultation diagnoses, and outcome of patients in the emergency department are included in the analysis.Results: Neurology consultation was requested for 347 (0.83%) patients among 41,850 emergency department admissions duringthe study period. The female/male distribution of consulted patients was 50.7% vs. 49.3%. The ambulatory admission and ambulancearrival rates to the emergency department were 51.9% (n = 180) and 48.1% (n = 167), respectively. Only neurology consultationwas requested for 227 patients (65.4%), while the additional consultation/consultations other than neurology consultation wereneeded for 120 (34.6%) patients. Diagnostic accuracy was 60.8% for the study sample and 71.2% for the patients requiring neurologyconsultation only. The diagnostic accuracy of ischemic stroke was 84.7%. The hospitalization rate of the study sample was 64% (n= 222). The majority of hospitalized patients were admitted by the neurology department (n = 182).Conclusion: The high accuracy of the diagnosis of ischemic stroke in this study may result from all neurology consultations in ouremergency department being requested by the emergency physician specialists. On the other hand, carefully integrated algorithmsand neurological examination training will be useful to improve diagnostic accuracy in other neurological emergencies.
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- 1. Lange MC, Braatz VL, Tomiyoshi C, et al. Neurological diagnoses in the emergency room: differences between younger and older patients. Arq Neuropsiquiatr 2011;69:212-6. 2. Nitkunan A. MacDonald BK. Boodhoo A, et al. A hyperacute neurology team - transforming emergency neurological care. Clin Med 2017;17:298-302. 3. Kottapally M, Josephson SA. Common neurologic emergencies for nonneurologists: When minutes count. Cleve Clin J Med 2016;83:116-26. 4. Vural S, Icme F, Kavakli HS, et al. A comparison study on the effectiveness of pager and telephone systems during emergency department consultations and length of stay of consulted emergency department patients. Turk J Clin Lab 2019;10:12-7. 5. Mapoure YN, Ongono JS, Nkouonlack C, et al. Neurological disorders in the emergency centre of the Douala General Hospital, Cameroon: A crosssectional study. Afr J Emerg Med 2015;5:165-70. 6. Owolabi LF, Shehu MY, Shehu MN, et al. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol 2010;13:167-70. 7. Gajurel BP, Parajuli P, Nepali R, et al. Spectrum of neurological disorders admitted in Tribhuvan University Teaching Hospital Maharajgunj. J Inst Med 2012;34:50-3. 8. Emre U, Demir AS, Acıman E, et al. The Profile of Neurology Patients Evaluated in the Emergency Department. Turk J Neurol 2009;15:134-9. 9. Hansen CK, Fisher J, Joyce N, et al. Emergency department consultations for patients with neurological emergencies. Eur J Neurol 2011;18:1317- 22. 10. Coban E, Mutluay B, Sen A, et al. Characteristics, diagnosis and outcome of patients referred to a specialized neurology emergency clinic: prospective observational study. Ann Saudi Med 2016;36:51-6. 11. Hamamci M. Stroke Incidence and Demographic Properties of Patients in Ardahan Province. Turk J Neurol 2019;25:129-34. 12. Barthélemy EJ, Benjamin E, Edouard Jean-Pierre MY, et al. A prospective emergency department-based study of pattern and outcome of neurologic and neurosurgical diseases in Haiti. World Neurosurg 2014;82:948-53. 13. Talabi OA. A 3-year review of neurologic admissions in University College Hospital Ibadan, Nigeria. West Afr J Med 2003;22:150-1. 14. Carroll C, Zajicek J. Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK. J Neurol Neurosurg Psychiatry 2004;75:406-9. 15. Vural S, Ramadan H. A short review on the comparison of consultation systems and tools in the emergency department practice: Tele-consultation. Cumhuriyet Med J 2019;41:239-43. 16. Moulin T, Sablot D, Vidry E, et al. Impact of emergency room neurologists on patient management and outcome. Eur Neurol 2003;50:207-14. 17. Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977;33:159-74. 18. Moeller JJ, Kurniawan J, Gubitz GJ, et al. Diagnostic accuracy of neurological problems in the emergency department. Can J Neurol Sci 2008;35:335-41.
- 19. Tarnutzer AA, Lee SH, Robinson KA, et al. ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: a meta-analysis. Neurology 2017;88:1468-77.
- 20. Mackay MT, Yock-Corrales A, Churilov L, et al. Accuracy and Reliability of Stroke Diagnosis in the Pediatric Emergency Department. Stroke 2017;48:1198-202.