Impact of emergency room neurologists on patient management and outcome.
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.


CONCLUSIONS
Our study stresses the need for a neurologist in the ER, both in quantitative terms and for the benefit of patient management.
Moulin
Thierry
T
Department of Neurology, University Hospital, Besançon, France. thierry.moulin@univ-fcomte.fr
Sablot
Denis
D
Vidry
Elisabeth
E
Belahsen
Faouzi
F
Berger
Eric
E
Lemounaud
Patrick
P
Tatu
Laurent
L
Vuillier
Fabrice
F
Cosson
Anne
A
Revenco
Eugeniu
E
Capellier
Gilles
G
Rumbach
Lucien
L
D001927:Brain Diseases / Q000628:therapy; D003710:Demography; D004632:Emergency Medical Services / Q000600:supply & distribution; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009462:Neurology; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D016896:Treatment Outcome; D000078329:Workforce