Impact of Emergency Room Neurologists on Patient Management and Outcome

Moulin, Thierry; Sablot, Denis; Vidry, E.; Belahsen, M.F.; Berger, Ėric; Lemounaud, Patrick; Tatu, Laurent; Vuillier, Fabrice; Cosson, Anne; Revenco, Eugeniu; Capellier, Gilles; Rumbach, L.

doi:10.1159/000073861

Cited by 124 publications

(89 citation statements)

References 20 publications

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“…8 This study is not likely reflective of Canadian ED practice, as 14.7% of all patients admitted to the emergency department had a formal neurological consultation.…”

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confidence: 85%

Diagnostic Accuracy of Neurological Problems in the Emergency Department

Moeller

Kurniawan

Gubitz

et al. 2008

Can. j. neurol. sci.

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Neurological disorders in the emergency department (ED) setting are diverse in presentation and diagnostic spectrum. At least 6% of all emergency department visits are for neurological problems. 1 An important issue is that of diagnostic accuracy. Previous retrospective analyses in the neurological literature have demonstrated that 5-11% of all patients given the diagnosis of stroke in the emergency department had another diagnosis altogether. [2][3][4] Similarly, 13-26% of patients referred to epilepsy ABSTRACT: Background: Previous studies describe significant rates of misdiagnosis of stroke, seizure and other neurological problems, but there are few studies examining diagnostic accuracy of all emergency referrals to a neurology service. This information could be useful in focusing the neurological education of physicians who assess and refer patients with neurological complaints in emergency departments. Methods: All neurological consultations in the emergency department at a tertiary-care teaching hospital were recorded for six months. The initial diagnosis of the requesting physician was recorded for each patient. This was compared to the initial diagnosis of the consulting neurologist and to the final diagnosis, as determined by retrospective chart review. Results: Over a six-month period, 493 neurological consultations were requested. The initial diagnosis of the requesting physician agreed with the final diagnosis in 60.4% (298/493) of cases, and disagreed or was uncertain in 35.7% of cases (19.1% and 16.6% respectively). In 3.9% of cases, the initial diagnosis of both the referring physician and the neurologist disagreed with the final diagnosis. Common misdiagnoses included neurocardiogenic syncope, peripheral vertigo, primary headache and psychogenic syndromes. Often, these were initially diagnosed as stroke or seizure. Conclusions: Our data indicate that misdiagnosis or diagnostic uncertainty occurred in over one-third of all neurological consultations in the emergency department setting. Benign neurological conditions, such as migraine, syncope and peripheral vertigo are frequently mislabeled as seizure or stroke. Educational strategies that emphasize emergent evaluation of these common conditions could improve diagnostic accuracy, and may result in better patient care. (19,1% et 16,6% respectivement). Chez 3,9% des cas, le diagnostic initial du médecin référant et du neurologue ne concordaient pas avec le diagnostic final. Les diagnostics erronés les plus fréquents étaient la syncope neurocardiogénique, le vertige d'origine périphérique, la céphalée primaire et les syndromes psychogéniques. Souvent ces cas recevaient un diagnostic initial d'un accident cérébrovasculaire ou de crise convulsive. Conclusions : Nos données révèlent qu'un diagnostic erroné ou incertain a été posé chez plus du tiers des patients vus à la salle d'urgence qui sont référés en neurologie. Des affections neurologiques bénignes comme la migraine, la syncope et le vertige d'origine périphérique sont fréquemment diagnostiqués c...

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“…8 This study is not likely reflective of Canadian ED practice, as 14.7% of all patients admitted to the emergency department had a formal neurological consultation.…”

mentioning

confidence: 85%

Diagnostic Accuracy of Neurological Problems in the Emergency Department

Moeller

Kurniawan

Gubitz

et al. 2008

Can. j. neurol. sci.

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“…From 8% to 15% of all patients admitted to the ER in general hospitals require assessment by a neurologist 2 . Generally, cerebrovascular disease (CVD), headache and epilepsy accounted for almost half of all acute admissions related to neurological diseases 3 , and elderly patients had the highest incidence of neurological symptoms during ER evaluation 2 . In Brazil, there is little information available on the characteristics of the neurological consultation that takes place in the ER.…”

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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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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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“…The presence of a neurologist in the emergency room has been proposed as a solution to improve this situation 24 . Overall, 20% of patients in our study were initially misdiagnosed in non-specialized hospitals or EMS, this being the principal cause of HDD and a cause of PHD.…”

Section: Discussionmentioning

confidence: 99%

Perception of stroke symptoms and utilization of emergency medical services

Hawkes

Farez

Calandri

et al. 2016

Arq. Neuro-Psiquiatr.

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Lack of stroke awareness and slow activation of emergency medical services (EMS) are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75%) arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02). Nineteen patients (20%) were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001). Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

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Impact of Emergency Room Neurologists on Patient Management and Outcome

Cited by 124 publications

References 20 publications

Diagnostic Accuracy of Neurological Problems in the Emergency Department

Diagnostic Accuracy of Neurological Problems in the Emergency Department

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

Perception of stroke symptoms and utilization of emergency medical services

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