A prospective evaluation of indications for neurological consultation in the emergency department

Abstract

BackgroundRecognizing the diverse presentation of neurological conditions that emergency physicians encounter can be challenging, and management of these patients often requires consultation with a neurologist. Accurate diagnosis is critical in neurological emergencies because patient outcomes are often dependent on timely treatment. Our primary objective was to ascertain whether consultant neurologists understood the reason for consultation in the emergency department.MethodsThe authors conducted a prospective study of a non-consecutive sample of 94 patients seen in an academic tertiary care emergency department (ED) who underwent consultation by neurologist over 4 consecutive months. At the time a consult was requested, we independently surveyed the treating ED physician for their differential diagnosis. Neurologists were also queried as to whether there was a clear indication for consultation. We then followed the patients to determine their final diagnosis and outcome.ResultsThe median age was 57 years (interquartile range 45–78). 45.7 % were male. The clinical reasons for all the consults were 61 % focal symptom, 12 % concern about a specific diagnosis, 9 % radiological finding, 9 % diagnostic ambiguity, and 11 % other. There was no significant difference in the rate of a final neurological diagnosis based on the clinical reason for consult (p = 0.13). In the 17 % of patients for whom the treating neurologist reported a lack of a clear indication for the consultation, 25 % were later admitted to a neurological service, and 69 % ultimately had a neurological diagnosis.ConclusionsAlthough patients with neurological emergencies can have diverse presentations, emergency physicians appear to utilize neurologic consultation appropriately. Additionally, nearly 70 % of patients for whom the consultant did not precisely understand the need for the consultation had neurological diagnoses. Time and resource constraints in the ED create challenges in making correct diagnosis.

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

“…The mean LOS in our ED (207 min) was longer than the LOS reported by Linden et al (156 min) but shorter than the LOS reported by Hoyer et al (250 min) and Hansen et al (408 min) [ 1 , 3 , 12 ]. The most frequently observed LOS in our study was 120–240 min (553 patients, 47.9%), and 218 patients (18.9%) stayed in the ED for >360 min.…”

Lost diagnoses in not otherwise specified headache in Emergency Department

“…Previous studies analyzed neurological examinations in ED focusing on motivations and frequencies of consultation, describing the diagnostic accuracy and the concordance rate between consultants and ED physicians [15][16][17]. Moeller et al 2008 reported that misdiagnosis or diagnostic uncertainly occurred in one-third of all neurological consultations in ED, especially for benign neurological conditions such as migraine.…”

Impaired Consciousness in the Emergency Department

“…There are different models for neurologic coverage in EDs such as neurohospitalists or teleneurology and prehospital rescue structures as well as in-hospital resources are quite different from country to country and even hospital to hospital [25]. Thus, each emergency center is forced to align their workup protocol to their current infrastructure and resources at present [10,26,27]. Some of these approaches have a neurological focus [26,28].…”