C K Hansen1, J Fisher, N Joyce, J A Edlow. 1. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Abstract
BACKGROUND: The spectrum of neurological emergencies that front-line physicians encounter is diverse. Appropriate assessment and neurological consultation is essential to good patient outcomes because many of these conditions depend on the rapid initiation of proper therapy. METHODS: In this retrospective study, we reviewed patients for whom the emergency physician elected to consult a neurologist to categorize the types of complaints, resources utilized, patient disposition and final diagnoses. RESULTS: Of the 500 patients analyzed in our study, the most common chief complaints were focal weakness (22%), headache (18.2%), dizziness or vertigo (16%), and seizure (14.2%). The most common reasons for neurological consultation were specific symptom (70.6%), concern for a specific diagnosis (17.4%), specific radiologic finding (9.2%), and ambiguity in the diagnosis (2.8%). Overall stroke accounted for 18.6% of the cases in our study. Non-contrast brain computed tomography was the most common imaging study (72.2%), and 37.0% of patients received advanced neuroimaging. The presentation of patients varied as 47% presented without having been seen by another healthcare professional, 24% were referred to the emergency department (ED) following by some other outpatient provider for evaluation, and 29% were transferred from another ED. CONCLUSIONS: Patients with neurological emergencies are common and consume a disproportionate amount of resources in the ED. Emergency physician training must target the modern evaluation of patients with a large variety of neurological emergencies and place special emphasis on the evaluation of patients with weakness, seizures, headache, and dizziness.
BACKGROUND: The spectrum of neurological emergencies that front-line physicians encounter is diverse. Appropriate assessment and neurological consultation is essential to good patient outcomes because many of these conditions depend on the rapid initiation of proper therapy. METHODS: In this retrospective study, we reviewed patients for whom the emergency physician elected to consult a neurologist to categorize the types of complaints, resources utilized, patient disposition and final diagnoses. RESULTS: Of the 500 patients analyzed in our study, the most common chief complaints were focal weakness (22%), headache (18.2%), dizziness or vertigo (16%), and seizure (14.2%). The most common reasons for neurological consultation were specific symptom (70.6%), concern for a specific diagnosis (17.4%), specific radiologic finding (9.2%), and ambiguity in the diagnosis (2.8%). Overall stroke accounted for 18.6% of the cases in our study. Non-contrast brain computed tomography was the most common imaging study (72.2%), and 37.0% of patients received advanced neuroimaging. The presentation of patients varied as 47% presented without having been seen by another healthcare professional, 24% were referred to the emergency department (ED) following by some other outpatient provider for evaluation, and 29% were transferred from another ED. CONCLUSIONS:Patients with neurological emergencies are common and consume a disproportionate amount of resources in the ED. Emergency physician training must target the modern evaluation of patients with a large variety of neurological emergencies and place special emphasis on the evaluation of patients with weakness, seizures, headache, and dizziness.
Authors: Richard B Lipton; Sagar Munjal; Dawn C Buse; Aftab Alam; Kristina M Fanning; Michael L Reed; Todd J Schwedt; David W Dodick Journal: Headache Date: 2019-08-13 Impact factor: 5.887