Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies

Abstract This study aims to evaluate the necessity of urgent neuroimaging for emergency admissions exhibiting symptomatology of profound hyponatremia. We retrospectively analyzed the medical records of all patients admitted to the emergency room of the University Hospital Münster from 2010 to 2014 w...

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Autores principales:	Arne Bokemeyer, Rainer Dziewas, Heinz Wiendl, Wolfram Schwindt, Paul Bicsán, Philipp Kümpers, Hermann Pavenstädt
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2017
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/86a4a78e1dff44c4ba2cc70d51fc5fb6
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spelling	oai:doaj.org-article:86a4a78e1dff44c4ba2cc70d51fc5fb62021-12-02T12:32:53ZHyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies10.1038/s41598-017-02030-62045-2322https://doaj.org/article/86a4a78e1dff44c4ba2cc70d51fc5fb62017-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-017-02030-6https://doaj.org/toc/2045-2322Abstract This study aims to evaluate the necessity of urgent neuroimaging for emergency admissions exhibiting symptomatology of profound hyponatremia. We retrospectively analyzed the medical records of all patients admitted to the emergency room of the University Hospital Münster from 2010 to 2014 with a serum sodium value < 125 mmol/L. From 52918 emergency admissions, 261 patients with profound hyponatremia were identified, of whom 140 (54%) had neurological symptoms. Unspecific weakness and confusion were the most prevalent of these symptoms (59%). Focal neurological signs [FNS] were present in 31% of cases and neuroimaging was performed in 68% (95/140) of symptomatic patients. Multiple logistic regression analysis identified FNS, seizures, altered consciousness and age as independent predictors for conducting neuroimaging (all p < 0.05). Significant pathological findings consistent with acute symptomatology were evident in 17 cases, all of whom had FNS. Recursive partitioning analyses confirmed FNS as the best predictor of neuroimaging pathology (p < 0.001). Absence of FNS had a negative predictive value of 100% [95% confidence interval: 93–100%] for excluding neuroimaging pathology. In conclusion, emergency patients with profound hyponatremia frequently show nonspecific-neurological symptoms and may undergo neuroimaging unnecessarily. The lack of FNS may serve as a valuable criterion for withholding neuroimaging until hyponatremia has been corrected.Arne BokemeyerRainer DziewasHeinz WiendlWolfram SchwindtPaul BicsánPhilipp KümpersHermann PavenstädtNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 7, Iss 1, Pp 1-7 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Arne Bokemeyer Rainer Dziewas Heinz Wiendl Wolfram Schwindt Paul Bicsán Philipp Kümpers Hermann Pavenstädt Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
description	Abstract This study aims to evaluate the necessity of urgent neuroimaging for emergency admissions exhibiting symptomatology of profound hyponatremia. We retrospectively analyzed the medical records of all patients admitted to the emergency room of the University Hospital Münster from 2010 to 2014 with a serum sodium value < 125 mmol/L. From 52918 emergency admissions, 261 patients with profound hyponatremia were identified, of whom 140 (54%) had neurological symptoms. Unspecific weakness and confusion were the most prevalent of these symptoms (59%). Focal neurological signs [FNS] were present in 31% of cases and neuroimaging was performed in 68% (95/140) of symptomatic patients. Multiple logistic regression analysis identified FNS, seizures, altered consciousness and age as independent predictors for conducting neuroimaging (all p < 0.05). Significant pathological findings consistent with acute symptomatology were evident in 17 cases, all of whom had FNS. Recursive partitioning analyses confirmed FNS as the best predictor of neuroimaging pathology (p < 0.001). Absence of FNS had a negative predictive value of 100% [95% confidence interval: 93–100%] for excluding neuroimaging pathology. In conclusion, emergency patients with profound hyponatremia frequently show nonspecific-neurological symptoms and may undergo neuroimaging unnecessarily. The lack of FNS may serve as a valuable criterion for withholding neuroimaging until hyponatremia has been corrected.
format	article
author	Arne Bokemeyer Rainer Dziewas Heinz Wiendl Wolfram Schwindt Paul Bicsán Philipp Kümpers Hermann Pavenstädt
author_facet	Arne Bokemeyer Rainer Dziewas Heinz Wiendl Wolfram Schwindt Paul Bicsán Philipp Kümpers Hermann Pavenstädt
author_sort	Arne Bokemeyer
title	Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
title_short	Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
title_full	Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
title_fullStr	Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
title_full_unstemmed	Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
title_sort	hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies
publisher	Nature Portfolio
publishDate	2017
url	https://doaj.org/article/86a4a78e1dff44c4ba2cc70d51fc5fb6
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Hyponatremia upon presentation to the emergency department – the need for urgent neuroimaging studies

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