The neurologist in the emergency department. An Italian nationwide epidemiological survey

Falco, Fabrizio Antonio de; Sterzi, Roberto; Toso, V.; Consoli, Domenico; Guidetti, Donata; Provinciali, Leandro; Leone, Maurizio; Beghi, Ettore

doi:10.1007/s10072-008-0864-y

Cited by 48 publications

(36 citation statements)

References 22 publications

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“…Improvement in CVD treatment must be undertaken in the ER. Until now, however, this treatment category has been underdeveloped, even in Europe, where only 28% of neurological centers have stroke units 1 . These units represent the most efficacious model for care provision compared with general ward care and stroke teams, but in Brazil, only few hospitals have them disponible 9 .…”

Section: Discussionmentioning

confidence: 99%

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Neurological diagnoses in the emergency room: differences between younger and older patients

Lange

Braatz

Novák

et al. 2011

Arq. Neuro-Psiquiatr.

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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. Key words: nervous-system disease, stroke, headache, seizures, emergency medical services, health services epidemiology.Diagnósticos neurológicos na sala de emergência: diferenças entre pacientes jovens e idosos RESUMO Doenças neurológicas são prevalentes na sala de emergência (SE). O objetivo deste estudo é comparar a ocorrência de diagnósticos neurológicos entre pacientes jovens e idosos atendidos na SE de um hospital terciário. Método: Pacientes admitidos na SE que necessitaram avaliação neurológica nas primeiras 24 horas após a admissão foram separados em dois grupos baseados na idade, ≤50 anos de idade e >50 anos de idade. Resultados: Doença cerebrovascular foi o diagnóstico mais comum nos pacientes >50 anos (59,6% vs. 21,8%, p<0,01). Convulsões (8,1% vs. 18,6%, p<0,01) e cefaléias primárias (3,7% vs. 114%, p<0,01) foram mais frequentes no grupo ≤50 anos. Conclusão: O presente estudo demonstrou que esses três diagnósticos neurológicos representam a maioria das avaliações neurológicas na SE. Diretrizes nacionais para os profissionais emergencistas que tratam estas doenças devem ser incluídos na prática clínica e no treinamento médico. Palavras-chave: doença do sistema nervoso, AVC, cefaléia, convulsões, serviço médico de emergência, epidemiologia em serviços de saúde.

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Section: Discussionmentioning

confidence: 99%

“…increasing public-health costs 1 . From 8% to 15% of all patients admitted to the ER in general hospitals require assessment by a neurologist 2 .…”

mentioning

confidence: 99%

Neurological diagnoses in the emergency room: differences between younger and older patients

Lange

Braatz

Novák

et al. 2011

Arq. Neuro-Psiquiatr.

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“…Headache ranks as fifth among all medical chief complaints in the emergency room (ER) and accounts for about 20% of all neurological ER consultations [1][2][3]. In headache patients, the frequency of a serious secondary cause has been reported to be 5-15% [4,5].…”

Section: Introductionmentioning

confidence: 99%

Headache in the emergency room: the role of immigrant background on the frequency of serious causes and diagnostic procedures

2011

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Headache is the most frequent neurological chief complaint in the emergency room (ER). During diagnostic workup, accurate history taking still is the mainstay for identification of patients with a serious underlying disorder. However, in patients with an immigrant background, language problems and cultural influences on pain perception and pain-associated behavior can pose serious challenges for physicians. Here, we have evaluated the epidemiological characteristics of the chief complaint headache in ER patients with a probable immigrant background. We performed a retrospective study on 4,132 consecutive neurological ER patients. Identification of patients with probable immigrant background was done by a name based algorithm. Epidemiological characteristics of ER headache patients with and without probable immigrant background were evaluated. Patients with a probable immigrant background had a higher frequency of headache as chief complaint compared to age- and sex-matched control patients (32 vs. 21%). In addition, headache patients with a probable immigrant background had a lower frequency of serious causes (5.2 vs. 16%). Approximately eight cranial imaging procedures and three lumbar punctures were performed for one serious diagnosis in patients with a probable immigrant background. In control patients, these ratios were three and one, respectively. Taken together, our data suggest that socio-cultural factors such as migrational status significantly affect pain-associated behavior of headache patients as well as the clinical workup in an ER. Culturally competent care may be optimized by interpreters, standardized headache questionnaires and easy access to cranial imaging when a benign etiology cannot be firmly established.

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“…In the emergency room (ER), dizziness accounts for 12–13% of neurological consultations, and ranks among the most frequent neurological chief complaints apart from headache and motor deficit [2,3]. In an international survey of 1,150 emergency physicians prioritizing clinical decision rules from all disciplines, ranking of diagnostic workup of vertigo was only exceeded by the investigation of a febrile child <36 months [4].…”

Section: Introductionmentioning

confidence: 99%

Dizziness in the Emergency Room: Diagnoses and Misdiagnoses

Royl

Ploner²,

Leithner³

2011

Eur Neurol

107

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Background: Dizziness is among the most frequent neurological chief complaints in emergency room (ER) patients. Although the majority of underlying disorders are benign, serious causes that require immediate in-hospital treatment may occur that are difficult to identify clinically. Methods: Retrospective study of 475 consecutive ER neurological consultations with dizziness as the chief complaint. Results: Of all ER dizziness patients, 73% were initially assigned to benign and 27% to serious diagnoses. The two most frequent disorders were benign paroxysmal positional vertigo (22%) and stroke (20%). On follow-up (available in 124 patients), 43% of all ER diagnoses were corrected: 6% of benign ER diagnoses were corrected to serious diagnoses, 23% of serious ER diagnoses were revised to benign. The most frequent corrections concerned patients with an ER diagnosis of stroke or vestibular neuronitis. Conclusions: In the patient sample studied here, serious causes of dizziness were more prevalent than can be expected from population-based surveys or data from specialized outpatient departments. However, inappropriate assignment of dizziness patients to benign diagnoses still occurred in a relevant proportion of patients. ER clinical pathways, planning of imaging resources and follow-up of patients in- and outside the hospital must take these points into consideration.

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The neurologist in the emergency department. An Italian nationwide epidemiological survey

Cited by 48 publications

References 22 publications

Neurological diagnoses in the emergency room: differences between younger and older patients

Neurological diagnoses in the emergency room: differences between younger and older patients

Headache in the emergency room: the role of immigrant background on the frequency of serious causes and diagnostic procedures

Dizziness in the Emergency Room: Diagnoses and Misdiagnoses

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