Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study

Cruz, Patrícia; Sánchez, J.R. Pérez; Cuello, Juan Pablo; García, P. Sobrino; Peracho, G. Vicente; Arratibel, A. García; Guzmán, Daniel Sánchez; Quelle, N. Bravo; Ruano, B. Gutiérrez; Morcillo, Cèsar; Henríquez, Felipe; Delgado, Francisco; González, A. Muñoz; Rubio, Rafael; Mohedano, A.M. Iglesias; Barriga, M.L. Martín; Casa-Fages, Beatriz De la; Otero, Francisco Javier Sanjiao; Ezpeleta, David; Pastor, A. García; Núñez, A. Gil

doi:10.1016/j.nrleng.2013.04.002

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…The mean annual rate of neurological consultation in emergency departments accounted for about 5–6% of acute medical admissions, ranging between 2 and 8%, with a peak of about 16%. These values, and the quite wide range of recording, have been previously reported in Italy [ 6 ] and in other European and non-European countries [ 7 – 9 ].…”

Section: Discussionsupporting

confidence: 80%

A snapshot of emergency neurology management in the Lombardy Region, Italy

et al. 2022

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Background The assessment of human and diagnostic resources is a prerequisite to improving the management of emergency neurology. Objective To provide a landscape on the organization of the Lombardy Region hospitals for emergency neurological care management. Methods We designed an anonymized questionnaire including 6 sections with 21 questions on facilities, human and diagnostic resources, and intra- and between-hospital connections. The time needed to fill the questionnaire was estimated not to exceed 6 min. Results The questionnaire was returned by 33/41 (80.5%) hospitals, 22 classified as level 1 (spoke), and 11 as level 2 (hub). Five of 33 (15%) did not have a neurology unit. The mean annual rate of neurological consultations accounted for 5–6% of all admissions (range 2–8%) and did not differ between levels 1 and 2 hospitals. Neurologists were 24-h available in 21/33 (64%) hospitals, 12-h and on call at night in 6 (18%), less than 12 h without nocturnal availability in 5 (15%), and neither present nor available in 1 (3%). Brain CT and CSF examinations were 24-h universally available, whereas EEG and neurosonology were not in most hospitals. Despite angio-CT was 24-h available in more than 75% of the hospitals, only 45% of them had 24-h availability of diffusion/perfusion imaging, and 43% were not available at any time. Only 12% of the hospitals had 24-h availability of neuroradiologists and 6% of interventional neuroradiologists. Conclusion Our data, while emphasizing current critical issues, offer clues for identifying priorities and improving the management of emergency and time-dependent neurological diseases.

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Section: Discussionsupporting

confidence: 80%

A snapshot of emergency neurology management in the Lombardy Region, Italy

et al. 2022

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“…The diagnoses made most frequently by neuro-emergency experts in the ED were acute ischemic stroke, benign paroxysmal positional vertigo, vestibular neuritis, seizures, cerebral hemorrhage, and metabolic encephalopathy. The order of diagnosis frequency in other studies was AIS, seizure, and headache [ 1 , 5 , 10 , 13 , 14 ]; our results had similar AIS frequency but fewer cases of headache. Most cases of primary headache with no abnormal findings on brain CT scans were discharged by the ED physicians after controlling their symptoms and referred for outpatient treatment.…”

Section: Discussionsupporting

confidence: 70%

“…However, neurology is still considered a complex and unknown area for most doctors [ 4 ]. The aging population, growing demand for neurological management, new developments in neuroimaging tests, and advanced treatments for acute stroke have increased the number and complexity of neurological emergency cases [ 5 ]. Neurological diseases are the most common cause of disability and the second leading cause of death; consequently, the responsibility and burden of emergency physicians have increased [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Jung

Kim

et al. 2021

IJERPH

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We aimed to evaluate the overall clinical characteristics of patients treated by a neuro-emergency expert dedicated to the emergency department (ED) as an attending neurologist during the COVID-19 pandemic. We included adult patients who visited the ED between 1 January and 31 December 2020 and were treated by a neuro-emergency expert. We retrospectively obtained and analyzed the data on patients’ clinical characteristics and outcome. The neuro-emergency expert treated 1155 patients (mean age, 62.9 years). The proportion of aged 18–40 years was the lowest, and the most common modes of arrival were public ambulance (50.6%) and walk-in (42.3%). CT and MRI examinations were performed in 94.4 and 33.1% of cases, respectively. The most frequent complaints were dizziness (31.8%), motor weakness (24.2%), and altered mental status (15.8%). The ED diagnoses were acute ischemic stroke (19.8%), benign paroxysmal positional vertigo (14.2%), vestibular neuritis (9.9%), and seizure (8.8%). The mean length of stay in the ED was 207 min. Of the patients, 55.0% were admitted to the hospital, and 41.8% were discharged for outpatient follow-up. Despite the longer stay and the complexity and difficulty of neurological diseases during the COVID-19 pandemic, the accurate diagnosis and treatment provided by a neuro-emergency expert can be presented as a good model in the ED.

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“…El actual programa formativo de la especialidad de neurología en España, vigente desde 2006 [ 1 ], especifica que los médicos internos residentes (MIR) de esta especialidad realizarán, de forma obligatoria, guardias específicas supervisadas por un neurólogo. Con ello se busca ofrecer una serie de habilidades consideradas necesarias y que son acordes al Plan Estratégico Nacional para el Tratamiento de las Enfermedades Neurológicas II [ 2 - 4 ]. La formación específica en urgencias neurológicas es, a su vez, uno de los requisitos de la Unión Europea de Médicos Especialistas y, por consiguiente, de exigencia para el acceso al European Board Examination in Neurology [ 5 , 6 ].…”

Section: Introductionunclassified

Guardias médicas durante la formación del residente de neurología en España: cambios en la última década

Gil¹,

Meza²,

Cerdán-Santacruz³

2022

RevNeurol

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Introducción. El programa formativo de neurología en España, aprobado en 2006, incide en la realización de guardias específicas supervisadas por un neurólogo. En una evaluación de la Comisión Nacional de Neurología en 2008, se constató un cumplimiento desigual de este objetivo docente: el 60,3% de las unidades ofrecía a sus residentes una guardia de 24 horas con supervisión física, y sólo el 43% era en su propio centro. Tras más de una década, y con un nuevo plan formativo en redacción, queremos conocer la situación actual y posibles factores implicados. Material y métodos. Estudio mediante encuestas autoadministradas a las unidades docentes de neurología que hubiesen formado recientemente una promoción completa de residentes (n = 77). Se recogieron respuestas entre octubre de 2021 y febrero de 2022. Resultados. Respondió el 100% de las unidades. En 2021, el 88,3% cumplía los objetivos docentes, con un 83% con guardias de 24 horas con supervisión física en su propio centro. Entre los factores relacionados, se observó una asociación directa y estadísticamente significativa con el tamaño del centro y la existencia de unidad de ictus. Discusión. La supervisión de residentes durante la guardia de neurología está siguiendo la línea marcada por el plan formativo y la comisión nacional de la especialidad, aunque siguen existiendo diferencias que van más allá de aspectos puramente asistenciales. El futuro plan estatal podría marcar nuevas pautas que nos ayuden a conseguir una menor heterogeneidad, a fin de ofrecer una misma capacitación en el abordaje urgente del paciente neurológico.

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Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study

Cited by 8 publications

References 20 publications

A snapshot of emergency neurology management in the Lombardy Region, Italy

A snapshot of emergency neurology management in the Lombardy Region, Italy

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

Guardias médicas durante la formación del residente de neurología en España: cambios en la última década

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