Emergency Physicians

Kothari, Rashmi; Brott, Thomas G.; Broderick, Joseph P.; Hamilton, C

doi:10.1161/01.str.26.12.2238

Cited by 103 publications

(23 citation statements)

References 15 publications

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“…Correct early diagnosis also improves the cost/benefit ratio of the stroke unit, as shown in the Lille experience, where up to 15% of the patients with no stroke were mistakenly admitted to this unit [4]. Other studies have reported similar errors in 1.5–19% of cases [16, 21]. In our study, a false positive diagnosis of stroke or TIA was suspected in 22.3% of our cases.…”

Section: Discussionsupporting

confidence: 65%

“…On the other hand, the assessment by a neurologist also made it possible to redirect more than one third of the patients admitted to the ER (17.4% were sent to another unit and 18.4% discharged). This effect, already demonstrated in the management of an ageing population [15], stroke [16], headaches [17], confusion [18], and non-convulsive SE [19], does seem particularly efficient when seen in the perspective of reducing length of hospital stay and improving cost efficiency and the quality of healthcare.…”

Section: Discussionmentioning

confidence: 89%

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Impact of Emergency Room Neurologists on Patient Management and Outcome

Moulin¹,

Sablot²,

Vidry³

et al. 2003

Eur Neurol

124

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The frequency and impact of in-patient assessment by a neurologist in the emergency room (ER) setting remain largely underestimated. The objective of our study was to analyse the impact of neurologist in-patient management. Methods: Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the ER, the ER team’s tentative neurological diagnosis, the neurology team’s final diagnosis and patient outcomes. The time interval between admission, call for a neurologist and the assessment by the neurologist were recorded. Results: Assessments by neurologists were performed in 14.7% (1,679/11,421) of all patients admitted to the ER. The mean time between admission and examination was 32 (± 36) min, irrespective of the day of the week, and dependent on the tentative diagnosis: shorter for stroke and status epilepticus (p < 0.05) and longer for confusion and vertigo (p < 0.05). The initial causes for examination were: stroke (33.1%), epilepsy (20%), loss of consciousness (9%), headaches (9%), confusion (5.4%), peripheral nervous system disorders (4.4%), vertigo (4.2%), cognitive dysfunctions (4%), gait disorders (3.2%) and miscellaneous (7.1%). Overall, false positive or negative diagnoses were produced by the ER in 37.3 and 36.6% of ER admissions, respectively. A complete change of diagnosis by the neurologist was found in 52.5% of patients. Of the patients undergoing a neurological examination, 18.4% were able to go home, 31.8% were admitted to the stroke unit, 32.4% to the general neurology unit and 17.4% to other departments. Conclusion: Our study stresses the need for a neurologist in the ER, both in quantitative terms and for the benefit of patient management.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 89%

Impact of Emergency Room Neurologists on Patient Management and Outcome

Moulin¹,

Sablot²,

Vidry³

et al. 2003

Eur Neurol

124

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“…It has been shown that accurate stroke diagnosis by physicians in the prehospital care system was 72% in a community of the Cincinnati area [35], increasing up to 98.6% after an educational intervention program [36,37,38]. In our study, accuracy in the prehospital diagnosis of stroke was 94.6%.…”

Section: Discussionmentioning

confidence: 44%

Benefits of a Prehospital Stroke Code System

Belvís

Cocho²,

Martí‐Fàbregas³

et al. 2005

Cerebrovasc Dis

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Background and Objectives: Hospital admission delay is a main limiting factor for effective thrombolytic therapy in stroke patients. We developed a stroke code system for rapid request of emergency transportation to the hospital and a priority availability of the attending neurologist on the patient’s arrival at the Emergency Department (ED). Methods: Over a 1-year period, a 24-hour telephone hotline between the attending neurologist and the Barcelona public emergency coordination service was established. Priority 1 (P1) was defined as a patient with symptoms suggestive of acute stroke with onset of less than 3 h, in which case immediate transportation service and rapid ED reception was organized. Data from patients in the P1 group (n = 39) and patients without activation of the stroke code (P0) (n = 181) were compared. Results: There were significant differences between P1 and P0 groups in mean time from ED arrival to request for neurologic assessment (4.4 ± 19.5 vs. 194.7 ± 244.9 min, p < 0.001), from arrival to neurologic examination (12.6 ± 21.1 vs. 225.3 ± 258.2 min, p < 0.005), and from arrival to performance of brain CT scan (35.5 ± 34.9 vs.120.3 ± 143.2 min, p < 0.001), and also in the number of patients treated with thrombolytic agents (19 vs. 4.5%, p < 0.003). There were no differences between groups in the time elapsed from stroke onset to ED arrival. Conclusions: Activation of the stroke code was effective in increasing the percentage of patients treated with thrombolytic drugs and also in shortening the delay from ED arrival until neurologic assessment and from ED arrival until brain CT.

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“…Factors that influence stroke differential diagnosis include presenting complaints, pattern of neurological deficits, available laboratory and imaging exams, and clinical expertise [4,5]. Most of the studies that evaluated diagnostic accuracy of SMs compared the diagnostic accuracy of neurologists and emergency physicians [6,7]. To the best of our knowledge, there are no studies in the current literature analyzing the repercussion of changes in Emergency Department shift patterns on the admission of SMs to a stroke unit.…”

Section: Introductionmentioning

confidence: 99%

Increase in the Admission of Stroke Mimics after Change in Emergency Shifts

Vargas

Costa²,

Melo³

et al. 2017

Cerebrovasc Dis

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Background: In 2010, changes were made to the shift pattern of neurology residents for cover in the Emergency Department at a university hospital. This resulted in a decrease in the number of emergency hours worked by neurology specialists and allowed for a natural quasi-experiment. Aim: We aimed to evaluate if changes to the number of emergency hours worked by neurology residents and specialist neurologists, (intervention) altered the number or pattern of admitted stroke mimics (SMs). Methods: Observational retrospective study from January 2007 to December 2013. Time of intervention was set as August 2010. We used a segmented linear regression - ARIMA - to evaluate changes in the temporal pattern of admitted SMs. A statistical correlation between the number of emergency hours worked by neurology residents and the number of admitted SMs was calculated using the Pearson Correlation Coefficient. Results: Of the 2,552 patients admitted to the stroke unit, 290 were SMs (11.4%). After August 2010, there was an increase in the number of admitted SMs (p = 0.003). After 2010, the most frequent SM diagnosis changed from a psychiatric condition to peripheral vertigo. A positive correlation was found between the number of hours worked primarily by neurology residents and the number of admitted SMs (Pearson correlation coefficient = 0.94; p = 0.002). Conclusions: Changes in the pattern of Emergency Department shifts were associated with an increase in the rate of admitted SMs and with a higher number of mimics with a final diagnosis of peripheral vertigo.

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Emergency Physicians

Cited by 103 publications

References 15 publications

Impact of Emergency Room Neurologists on Patient Management and Outcome

Impact of Emergency Room Neurologists on Patient Management and Outcome

Benefits of a Prehospital Stroke Code System

Increase in the Admission of Stroke Mimics after Change in Emergency Shifts

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