title: An integrated model of care for neurological infections: the first six years of referrals to a specialist service at a university teaching hospital in Northwest England.
abstract: BACKGROUND
  A specialist neurological infectious disease service has been run jointly by the departments of infectious disease and neurology at the Royal Liverpool University Hospital since 2005. We sought to describe the referral case mix and outcomes of the first six years of referrals to the service.
  
  
  METHODS
  Retrospective service review.
  
  
  RESULTS
  Of 242 adults referred to the service, 231 (95%) were inpatients. Neurological infections were confirmed in 155 (64%), indicating a high degree of selection before referral. Viral meningitis (35 cases), bacterial meningitis (33) and encephalitis (22) accounted for 38% of referrals and 61% of confirmed neurological infections. Although an infrequent diagnosis (n = 19), neurological TB caused the longest admission (median 23, range 5-119 days). A proven or probable microbiological diagnosis was found in 100/155 cases (64.5%). For the whole cohort, altered sensorium, older age and longer hospital stay were associated with poor outcome (death or neurological disability); viral meningitis was associated with good outcome. In multivariate analysis altered sensorium remained significantly associated with poor outcome, adjusted odds ratio 3.04 (95% confidence interval 1.28-7.22, p = 0.01).
  
  
  CONCLUSIONS
  A service of this type provides important specialist care and a focus for training and clinical research on complex neurological infections.
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. lturtle@liverpool.ac.uk.|Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. lturtle@liverpool.ac.uk.|NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK. lturtle@liverpool.ac.uk.
authors.forename: Lance
authors.initials: L
authors.lastname: Turtle
authors.affiliation: Leeds General Infirmary, Leeds, LS1 3EX, UK. Agam.Jung@leedsth.nhs.uk.
authors.forename: Agam
authors.initials: A
authors.lastname: Jung
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. Nicholas.Beeching@rlbuht.nhs.uk.|NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK. Nicholas.Beeching@rlbuht.nhs.uk.|Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. Nicholas.Beeching@rlbuht.nhs.uk.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Beeching
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. d.cocker@doctors.org.uk.|Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. d.cocker@doctors.org.uk.
authors.forename: Derek
authors.initials: D
authors.lastname: Cocker
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. gerrydavies@doctors.org.uk.|Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. gerrydavies@doctors.org.uk.
authors.forename: Gerry R
authors.initials: GR
authors.lastname: Davies
authors.affiliation: Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, UK. andrew.nicolson@thewaltoncentre.nhs.uk.
authors.forename: Andy
authors.initials: A
authors.lastname: Nicolson
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. Mike.Beadsworth@rlbuht.nhs.uk.|NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK. Mike.Beadsworth@rlbuht.nhs.uk.
authors.forename: Michael Bj
authors.initials: MB
authors.lastname: Beadsworth
authors.affiliation: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. alastairmiller@me.com.
authors.forename: Alastair Ro
authors.initials: AR
authors.lastname: Miller
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. tsolomon@liv.ac.uk.|NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK. tsolomon@liv.ac.uk.|Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, UK. tsolomon@liv.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
mesh_terms: D000328:Adult; D003141:Communicable Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D003953:Diagnosis-Related Groups; D004660:Encephalitis / Q000175:diagnosis / Q000453:epidemiology; D004739:England; D005260:Female; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000628:therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome; D016526:Workload