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

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 Hospita...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Hoyer C, Stein P, Ebert A, Rausch HW, Nagel S, Eisele P, Alonso A, Platten M, Szabo K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	neurology emergency Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/fe2a445066394d00b228a993d2f22949
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:fe2a445066394d00b228a993d2f22949
record_format	dspace
spelling	oai:doaj.org-article:fe2a445066394d00b228a993d2f229492021-12-02T09:43:27ZComparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study1178-2021https://doaj.org/article/fe2a445066394d00b228a993d2f229492020-02-01T00:00:00Zhttps://www.dovepress.com/comparing-expert-and-non-expert-assessment-of-patients-presenting-with-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Carolin 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 carolin.hoyer@umm.deObjective: 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, emergencyHoyer CStein PEbert ARausch HWNagel SEisele PAlonso APlatten MSzabo KDove Medical PressarticleneurologyemergencyNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 447-456 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	neurology emergency Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	neurology emergency Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Hoyer C Stein P Ebert A Rausch HW Nagel S Eisele P Alonso A Platten M Szabo K Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
description	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 carolin.hoyer@umm.deObjective: 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
format	article
author	Hoyer C Stein P Ebert A Rausch HW Nagel S Eisele P Alonso A Platten M Szabo K
author_facet	Hoyer C Stein P Ebert A Rausch HW Nagel S Eisele P Alonso A Platten M Szabo K
author_sort	Hoyer C
title	Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
title_short	Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
title_full	Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
title_fullStr	Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
title_full_unstemmed	Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
title_sort	comparing expert and non-expert assessment of patients presenting with neurological symptoms to the emergency department: a retrospective observational study
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/fe2a445066394d00b228a993d2f22949
work_keys_str_mv	AT hoyerc comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT steinp comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT eberta comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT rauschhw comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT nagels comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT eiselep comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT alonsoa comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT plattenm comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy AT szabok comparingexpertandnonexpertassessmentofpatientspresentingwithneurologicalsymptomstotheemergencydepartmentaretrospectiveobservationalstudy
_version_	1718398043314716672

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

Ejemplares similares