Neuropsychiatric Disease and Treatment (Feb 2020)

Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study

  • Hoyer C,
  • Stein P,
  • Ebert A,
  • Rausch HW,
  • Nagel S,
  • Eisele P,
  • Alonso A,
  • Platten M,
  • Szabo K

Journal volume & issue
Vol. Volume 16
pp. 447 – 456

Abstract

Read online

Carolin Hoyer,1 Patrick Stein,1 Anne Ebert,1 Hans-Werner Rausch,1 Simon Nagel,2 Philipp Eisele,1 Angelika Alonso,1 Michael Platten,1 Kristina Szabo1 1Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University, Mannheim, Germany; 2Department of Neurology, University Hospital, Heidelberg University, Mannheim, GermanyCorrespondence: Carolin HoyerDepartment of Neurology, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68135, GermanyTel +49-621-383-2885Fax +49-621-383-3807Email [email protected]: Referrals to neurology in emergency departments (ED) are continuously increasing, currently representing 15% of all admissions. Existing triage systems were developed for general medical populations and have not been validated for patients with neurological symptoms.Methods: To characterize neurological emergencies, we first retrospectively analyzed symptoms, service times and resources of the cohort of neurological referrals to a German interdisciplinary ED (IED) during 2017 according to urgency determined by final IED diagnosis. In a second step, we performed a retrospective assignment of consecutive patients presenting in April 2017 according to internal guidelines as either acute (requiring diagnostic/therapeutic procedures within 24 hrs) or non-acute neurological conditions as well as a retrospective classification according to the Emergency Severity Index (ESI). Both assessments were compared with the urgency according to the final ER diagnosis.Results: In a 12-month period, 36.4% of 5340 patients were rated as having an urgent neurological condition; this correlated with age, door-to-doctor time, imaging resource use and admission (p < 0.001, respectively). In a subset of 275 patients, 59% were retrospectively triaged as acute according to neurological expertise and 48% according to ESI categories 1 and 2. Neurological triage identified urgency with a significantly higher sensitivity (94.8, p < 0.01) but showed a significantly lower specificity (55.1, p < 0.05) when compared to ESI (80.5 and 65.2, respectively).Conclusion: The ESI may not take specific aspects of neurological emergency (eg, time-sensitivity) sufficiently into account. Refinements of existing systems or supplementation with dedicated neurological triage tools based on neurological expertise and experience may improve the triage of patients with neurological symptoms.Keywords: neurology, emergency

Keywords