title: The neurologist in the emergency department. An Italian nationwide epidemiological survey.
abstract: A nationwide survey has been undertaken to evaluate the resources and the activities of Italian hospital neurology units (NU) in the emergency setting. NU are widely disseminated throughout the entire country and 220 (84%) are located in hospitals with an emergency room (ER). Complete data about hospital setting, structural and functional characteristics of each NU and clinical activities were obtained from 159 (72.3%). Each NU has, on average, 25 beds (7% bedside monitoring), 7 neurologists and 17 nurses. A neuroscience department is present in 25% of the hospitals. The ER is the source of 71% of the 148,040 annual admissions and of 57% of the 577,279 annual neurological consultations. Stroke is the most common cause of admission (29%), followed by epilepsy/headache and transient ischaemic attacks. Head trauma prevails in hospitals with no neurosurgical units. Cerebrovascular disorders are the main cause of neurological consultations (28%), followed by headache (22%), dizziness (13%), head trauma (13%), impairment of consciousness (12%) and epilepsy (9%). Only 36% of NU have a 24-h/day, 7 days/week on-duty neurologist and 28% have a stroke unit. The burden of neurological activities is unrelated to the geographical area and hospital's complexity (size, structural and functional context, ER organisation, presence of stroke units, neurosurgery units or 24/7 neurological service).
authors.affiliation: Neurology Unit, Loreto Nuovo Hospital, Via Vespucci 15, 80121, Naples, Italy. defalco@tin.it
authors.forename: Fabrizio Antonio
authors.initials: FA
authors.lastname: de Falco
authors.forename: Roberto
authors.initials: R
authors.lastname: Sterzi
authors.forename: Vito
authors.initials: V
authors.lastname: Toso
authors.forename: Domenico
authors.initials: D
authors.lastname: Consoli
authors.forename: Donata
authors.initials: D
authors.lastname: Guidetti
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.forename: Maurizio A
authors.initials: MA
authors.lastname: Leone
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
mesh_terms: D001927:Brain Diseases / Q000453:epidemiology* / Q000628:therapy; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000453:epidemiology / Q000628:therapy; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data; D006748:Hospital Departments / Q000458:organization & administration / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000628:therapy; D007558:Italy / Q000453:epidemiology; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D009462:Neurology / Q000706:statistics & numerical data / Q000639:trends*; D010343:Patient Admission / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data