Comparing Expert and Non-Expert Assessment of Patients Presenting with Neurological Symptoms to the Emergency Department: A Retrospective Observational Study
Received 27 October 2019
Accepted for publication 28 December 2019
Published 13 February 2020 Volume 2020:16 Pages 447—456
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
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, Germany
Correspondence: Carolin Hoyer
Department of Neurology, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68135, Germany
Objective: 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
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