Characteristics, diagnosis and outcome of patients referred to a specialized neurology emergency clinic: prospective observational study

Abstract

BACKGROUND: Organization and management of neurological emergencies differs among hospitals. Some have specialized neurological emergency rooms (ER). OBJECTIVES: The purpose of this study was to determine the characteristics, diagnosis and outcome of patients referred to a specialized emergency neurology clinic. DESIGN: Prospective, observational study of consecutive patients presenting between March 2014 and July 2014. SETTING: Neurologicaler of a training and research neuropsychiatric hospital. PATIENTS AND METHODS: Patients older than 16 years of age with a neurological complaint were assessed by neurological exam, laboratory and imaging tests including brain computed tomography (CT), brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis, electroencephalography or electromyography. MAIN OUTCOME MEASURES: Types of diagnosis. RESULTS: Of 4500 patients, 2602 (57.8%) were female, and the mean age was 49.2 (23.6) years. The most common symptom was headache, which presented in 30.8% of all patients. The three most common diagnoses after emergency work-up were headache (27.8%), stroke (20.6%) and peripheral vertigo (13%). In the ER, CT was performed on 65.5% of patients and MRI on 66.9%. After emergency work-up, 72.2% patients were discharged home. CONCLUSIONS: Neurological diseases are common, with headache and cerebrovascular diseases being the most frequent diagnosis in this specialized ER. CT and MRI are most often used to diagnose or exclude neurological diseases. Many patients do not require immediate hospitalization. The two most frequent diagnoses for hospitalization were stroke and demyelinating disease. LIMITATIONS: Absence of follow up data on patients discharged home.