Descriptive analysis of neurological in-hospital consultations in a tertiary hospital

Aller-Alvarez, J.S.; Quintana, Manuel; Santamarina, Estevo; Alvarez-Sabín, J

doi:10.1016/j.nrleng.2015.08.008

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…The consulting neurologists proposed additional exams and suggested changes for treatment plans in the vast majority of patients. These numbers are greater than what previous studies reported [8,9,12], perhaps due to more frequent AIS diagnoses which almost always imply ancillary tests and treatment changes. Proposing additional investigation also appears to lead to more frequent changes in treatment plans and also lower need for additional referrals, in line with what other studies report in general hospitals [6][7][8][9]12], highlighting the importance of the neurologist's outlook.…”

Section: Discussioncontrasting

confidence: 73%

“…Several other studies highlighted the importance and benefit of neurology consultations, revealing changes in diagnoses and management plans of inpatients, as well as facilitating early diagnosis and possibly early discharges [4][5][6][7][8][9][10][11]. Recent studies highlight that besides internal medicine, cardiology and cardiovascular units (whether intermediate or intensive care units) are among the most common specialties requiring neurology consultations [8,10,12]. Additionally, cerebrovascular disease is one of the most frequent diagnoses in inpatient consultations [8][9][10]12], particularly cardiology and cardiovascular units.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies highlight that besides internal medicine, cardiology and cardiovascular units (whether intermediate or intensive care units) are among the most common specialties requiring neurology consultations [8,10,12]. Additionally, cerebrovascular disease is one of the most frequent diagnoses in inpatient consultations [8][9][10]12], particularly cardiology and cardiovascular units. Nevertheless, the importance of a neurohospitalismbased model of care in cardiovascular units and hospitals is still not well defined.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Neurohospitalism in a Specialized Cardiovascular Hospital

Serôdio,

Magriço,

Sobral-Pinho

et al. 2024

Eur Neurol

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Introduction: Cardiology and cardiothoracic surgery are among the specialties that most commonly require neurology inpatient consultations. We aimed to study the neurology referrals by the cardiovascular-specialized hospital included in our tertiary hospital center. Methods: Retrospective study of consecutive patients referred for neurology inpatient consultation between January 1, 2020, and December 31, 2022. We analyzed referrals, patients’ characteristics, and the approach taken. A detailed subanalysis was performed for patients diagnosed with acute ischemic stroke (AIS). Results: 143 patients were observed (mean age 67.3 years, 46 [32.2%] females). Most frequent referral reasons were suspected AIS deficits (39.2%), altered mental status (19.6%), suspected seizures (13.3%), and neuroprognostication (11.9%). Mean referral-to-consult time was 2.7 days, and 117 (81.8%) consults were in-person. Additional investigation, treatment changes, and outpatient clinic referral were proposed, respectively, in 79.7%, 60.1%, and 19.6% of patients. Most common diagnoses were AIS (45.5%), hypoxic-ischemic encephalopathy (18.9%), and delirium (7.0%). Regarding patients with AIS (n = 62), most common stroke causes were post-cardiac procedure (44.6%), infective endocarditis (18.5%), aortic dissection (10.8%), acute myocardial infarction (10.8%), and anticoagulant withdrawal in patients with atrial fibrillation (6.2%). Thirty-four AIS patients were diagnosed less than 24 h since last seen well, of which four (6.2%) were treated (three with thrombolysis and one with mechanical thrombectomy). Conclusion: AIS is the most common reason for referral in our cardiovascular hospital. Our results highlight the importance of the availability of a neurologist/neurohospitalist with stroke expertise for consultation of inpatients admitted in a specialized cardiovascular hospital.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Role of Neurohospitalism in a Specialized Cardiovascular Hospital

Serôdio,

Magriço,

Sobral-Pinho

et al. 2024

Eur Neurol

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Clinical Characteristics of Involuntary Movement in Hospitalized Patients

Kwon

Lee

et al. 2019

JMD

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ObjectiveNeurological symptoms in hospitalized patients are not rare, and neurological consultation for movement disorders is especially important in evaluating or managing those with various movement disorders. Therefore, we investigated a clinical pattern of in-hospital consultations for various movement disorders in a tertiary care university hospital.MethodsOver two years, a total of 202 patients (70.7 ± 11.8 years of age) presenting with movement disorders referred to movement disorder specialists were investigated.ResultsThe main symptoms referred by nonneurologists were tremor (56.9%), parkinsonism (16.8%), and gait disturbance (8.9%). The most frequent diagnostic category was toxic/metabolic-caused movement disorder (T/MCMD) (35%) with regard to medications, followed by Parkinson’s disease (PD) (16%). Regarding the mode of onset, T/MCMD was the leading cause for acute (68%) and subacute onset (46%), while PD was the leading disorder (31%) for chronic onset.ConclusionThe current study showed a characteristic pattern of inpatients presenting with movement disorders. Furthermore, our findings highlighted the clinical significance of drug use or metabolic problems for treating this patient population.

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Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study

Hoyer

Stein

Ebert

et al. 2020

NDT

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Objective: Referrals to neurology in emergency departments (ED) are continuously increasing, currently representing 15% of all admissions. Existing triage systems were developed for general medical populations and have not been validated for patients with neurological symptoms. Methods: To characterize neurological emergencies, we first retrospectively analyzed symptoms, service times and resources of the cohort of neurological referrals to a German interdisciplinary ED (IED) during 2017 according to urgency determined by final IED diagnosis. In a second step, we performed a retrospective assignment of consecutive patients presenting in April 2017 according to internal guidelines as either acute (requiring diagnostic/therapeutic procedures within 24 hrs) or non-acute neurological conditions as well as a retrospective classification according to the Emergency Severity Index (ESI). Both assessments were compared with the urgency according to the final ER diagnosis. Results: In a 12-month period, 36.4% of 5340 patients were rated as having an urgent neurological condition; this correlated with age, door-to-doctor time, imaging resource use and admission (p < 0.001, respectively). In a subset of 275 patients, 59% were retrospectively triaged as acute according to neurological expertise and 48% according to ESI categories 1 and 2. Neurological triage identified urgency with a significantly higher sensitivity (94.8, p < 0.01) but showed a significantly lower specificity (55.1, p < 0.05) when compared to ESI (80.5 and 65.2, respectively). Conclusion: The ESI may not take specific aspects of neurological emergency (eg, timesensitivity) sufficiently into account. Refinements of existing systems or supplementation with dedicated neurological triage tools based on neurological expertise and experience may improve the triage of patients with neurological symptoms.

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Descriptive analysis of neurological in-hospital consultations in a tertiary hospital

Cited by 3 publications

References 11 publications

The Role of Neurohospitalism in a Specialized Cardiovascular Hospital

The Role of Neurohospitalism in a Specialized Cardiovascular Hospital

Clinical Characteristics of Involuntary Movement in Hospitalized Patients

<p>Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study</p>

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