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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2020-02-01
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| Series: | Neuropsychiatric Disease and Treatment |
| Subjects: | |
| Online Access: | https://www.dovepress.com/comparing-expert-and-non-expert-assessment-of-patients-presenting-with-peer-reviewed-article-NDT |
| _version_ | 1818992257425997824 |
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| 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 |
| collection | DOAJ |
| 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 |
| first_indexed | 2024-12-20T20:23:17Z |
| format | Article |
| id | doaj.art-fe2a445066394d00b228a993d2f22949 |
| institution | Directory Open Access Journal |
| issn | 1178-2021 |
| language | English |
| last_indexed | 2024-12-20T20:23:17Z |
| publishDate | 2020-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Neuropsychiatric Disease and Treatment |
| spelling | doaj.art-fe2a445066394d00b228a993d2f229492022-12-21T19:27:31ZengDove Medical PressNeuropsychiatric Disease and Treatment1178-20212020-02-01Volume 1644745651824Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational StudyHoyer CStein PEbert ARausch HWNagel SEisele PAlonso APlatten MSzabo KCarolin 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, emergencyhttps://www.dovepress.com/comparing-expert-and-non-expert-assessment-of-patients-presenting-with-peer-reviewed-article-NDTneurologyemergency |
| spellingShingle | 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 Neuropsychiatric Disease and Treatment neurology emergency |
| title | 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_short | 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 |
| topic | neurology emergency |
| url | https://www.dovepress.com/comparing-expert-and-non-expert-assessment-of-patients-presenting-with-peer-reviewed-article-NDT |
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