title: Emergency department consultations for patients with neurological emergencies.
abstract: BACKGROUND
  The spectrum of neurological emergencies that front-line physicians encounter is diverse. Appropriate assessment and neurological consultation is essential to good patient outcomes because many of these conditions depend on the rapid initiation of proper therapy.
  
  
  METHODS
  In this retrospective study, we reviewed patients for whom the emergency physician elected to consult a neurologist to categorize the types of complaints, resources utilized, patient disposition and final diagnoses.
  
  
  RESULTS
  Of the 500 patients analyzed in our study, the most common chief complaints were focal weakness (22%), headache (18.2%), dizziness or vertigo (16%), and seizure (14.2%). The most common reasons for neurological consultation were specific symptom (70.6%), concern for a specific diagnosis (17.4%), specific radiologic finding (9.2%), and ambiguity in the diagnosis (2.8%). Overall stroke accounted for 18.6% of the cases in our study. Non-contrast brain computed tomography was the most common imaging study (72.2%), and 37.0% of patients received advanced neuroimaging. The presentation of patients varied as 47% presented without having been seen by another healthcare professional, 24% were referred to the emergency department (ED) following by some other outpatient provider for evaluation, and 29% were transferred from another ED.
  
  
  CONCLUSIONS
  Patients with neurological emergencies are common and consume a disproportionate amount of resources in the ED. Emergency physician training must target the modern evaluation of patients with a large variety of neurological emergencies and place special emphasis on the evaluation of patients with weakness, seizures, headache, and dizziness.
authors: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors: C K
authors: CK
authors: Hansen
authors: J
authors: J
authors: Fisher
authors: N
authors: N
authors: Joyce
authors: J A
authors: JA
authors: Edlow
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D009462:Neurology / Q000592:standards*; D010342:Patient Acceptance of Health Care; D011787:Quality of Health Care / Q000592:standards; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies