Neurological emergencies in India--lessons learnt and strategies to improve outcomes.
BACKGROUND
Neurological emergencies account for between 2.6 and 14% of medical emergencies, a number that can be salvaged, if addressed in time. This study aimed to answer the questions of demand, type and outcome of neurological emergencies by conducting a retrospective analysis of neurological emergencies serviced by 108, the first professional emergency service in India.


METHODS
During the period between January 1, 2007 and December 31, 2008, a total of 24,760 calls were received by 108, of which confirmed neurological emergencies (n = 14,448) were followed up and evaluated. Risk factor analysis and stratification were done with respect to survival outcome at 48/120 h.


RESULTS
The subjects had a mean age of 37.4 (+/-19.5) years, were mainly male (63%) and were victims of seizures (51.5%), stroke (24%) or unconsciousness (21%). Risk stratification observed that rural area (p < 0.001), emergencies of stroke and coma (p < 0.001), age (p < 0.001), lower vital sign measurements (p < 0.001) and time to reach hospital (p = 0.05) were the main risk factors.


CONCLUSIONS
Emergency medical systems should implement a prehospital stroke protocol including the use of vital sign monitoring, point-of-care clinical diagnostics and advance forewarning systems. Geriatric clinics attending to the elderly age group, especially located in rural areas, with better identification of stroke and coma as medical emergencies, either through neuroimaging or clinical diagnostic facilities, will definitely improve outcomes. As seizures form a large chunk of neurological emergencies, genetic testing and counseling to detect hereditary causes could identify and keep most victims on regulated treatment in order to reduce adverse outcomes.
Saddichha
Sahoo
S
Division of Clinical Research, Emergency Management and Research Institute, Hyderabad 500014, India. saddichha@gmail.com
Saxena
Mukul Kumar
MK
Vibha
Pandey
P
Methuku
Mithilesh
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007858:Learning; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult