Letter to the Editor
Analysis of in-hospital consultations between the emergency department and the on-call neurologist due to headaches
Análisis de las interconsultas al neurólogo de guardia por cefaleas en un servicio de urgencias
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Matías-Guiu, J. Porta-Etessam, D. García-Azorín, F.J. Martín-Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.A." "apellidos" => "Matías-Guiu" "email" => array:1 [ 0 => "jordimatiasguiu@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Porta-Etessam" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "García-Azorín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F.J." "apellidos" => "Martín-Sánchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria, Hospital San Clínico Carlos, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de las interconsultas al neurólogo de guardia por cefaleas en un servicio de urgencias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It was with great interest that we read the study conducted by Rodríguez-Cruz et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> on the workload of on-call emergency department neurologists at Hospital Gregorio Marañón in Madrid. In this study, the authors analysed the number of patients assessed by the on-call neurologist during one year and found that neurological emergencies accounted for a large percentage of the total at 3.5%. Of these neurological emergencies, cerebrovascular accidents were the most frequent.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The percentage of neurological patients attended by the emergency department may be even higher if we count those neurological conditions that are not assessed by the on-call neurologist. This may be especially evident in certain diseases, such as headache. While headache is the most frequent reason for visiting a neurologist, its risk in a patient seeking medical attention in the emergency department is difficult to assess.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> With this in mind, we conducted a descriptive study of a series of patients who visited the emergency department due to headache. The study was conducted at a tertiary care university hospital with a 24-hour on-call neurology team formed by a neurology specialist and 2 resident neurologists between 1 January and 31 December 2013. We gathered data from the odd months by systematic sampling. We used the patients’ electronic medical records at the emergency department to gather demographic, diagnostic, and allocation data (admissions, transfers, etc.).</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 287 patients were included in our study; in 81 cases (28.2%), the emergency department called for a neurology consult. Forty-six patients (16%) were admitted whereas the rest were discharged. Thirty-six (44.4%) of the cases motivating a neurology consult were admitted to hospital, vs only 10 (4.8%) of the patients who were not evaluated by neurologists (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001).</p><p id="par0020" class="elsevierStylePara elsevierViewall">These data prove that the prevalence of neurological diseases in the emergency department –headache in this example– is even higher considering the cases that are not evaluated by neurologists. The increase in the number of consultations with the on-call neurologist, which has been reported in recent studies,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> confirms the high prevalence of neurological diseases that may motivate emergency neurology consults. Certain conditions, such as headaches, may result in fewer consultations than acute focal neurological signs, meaning that their frequency may be underestimated if we only count the patients evaluated by the on-call neurologist. A similar phenomenon is seen with other entities, such as epilepsy, in which the rate of consultations with the neurology department reaches 55%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> For this reason, future studies should assess all the patients attended in the emergency department to estimate the real prevalence and distribution of emergency care for neurological disease and establish clear criteria for emergency neurological assessment. This will serve to improve healthcare quality and patient safety in hospital emergency departments.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Matías-Guiu JA, Porta-Etessam J, García-Azorín D, Martín-Sánchez FJ. Análisis de las interconsultas al neurólogo de guardia por cefaleas en un servicio de urgencias. Neurología. 2016;31:577.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Labor asistencial del equipo de guardia de neurología en un hospital terciario de Madrid: análisis prospectivo durante un año" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.M. Rodríguez-Cruz" 1 => "J.R. Pérez-Sánchez" 2 => "J.P. Cuello" 3 => "P. Sobrino García" 4 => "G. Vicente Peracho" 5 => "A. 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García Ochoa" 3 => "R. de Elías Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "84" "paginaFinal" => "90" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La seguridad del paciente en urgencias y emergencias: balance de cuatro años del Programa SEMES-seguridad Paciente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Tomás Vecina" 1 => "M.R. Chanovas Borràs" 2 => "F. Roqueta" 3 => "T. Toranzo Cepeda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "225" "paginaFinal" => "233" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003100000008/v1_201609280237/S2173580816300864/v1_201609280237/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003100000008/v1_201609280237/S2173580816300864/v1_201609280237/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580816300864?idApp=UINPBA00004N" ]
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| 2019 September | 9 | 4 | 13 |
| 2019 August | 6 | 2 | 8 |
| 2019 July | 17 | 12 | 29 |
| 2019 June | 34 | 16 | 50 |
| 2019 May | 63 | 19 | 82 |
| 2019 April | 10 | 3 | 13 |
| 2019 March | 5 | 1 | 6 |
| 2019 February | 10 | 6 | 16 |
| 2019 January | 6 | 1 | 7 |
| 2018 December | 6 | 0 | 6 |
| 2018 November | 7 | 4 | 11 |
| 2018 October | 14 | 11 | 25 |
| 2018 September | 3 | 0 | 3 |
| 2018 August | 1 | 1 | 2 |
| 2018 July | 1 | 1 | 2 |
| 2018 June | 2 | 2 | 4 |
| 2018 May | 8 | 6 | 14 |
| 2018 April | 6 | 2 | 8 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 0 | 1 | 1 |
| 2018 January | 6 | 1 | 7 |
| 2017 December | 6 | 0 | 6 |
| 2017 November | 9 | 2 | 11 |
| 2017 October | 4 | 2 | 6 |
| 2017 September | 4 | 6 | 10 |
| 2017 August | 8 | 2 | 10 |
| 2017 July | 9 | 0 | 9 |
| 2017 June | 11 | 5 | 16 |
| 2017 May | 2 | 8 | 10 |
| 2017 April | 5 | 1 | 6 |
| 2017 March | 9 | 23 | 32 |
| 2017 February | 9 | 1 | 10 |
| 2017 January | 2 | 3 | 5 |
| 2016 December | 12 | 6 | 18 |
| 2016 November | 27 | 6 | 33 |
| 2016 October | 43 | 10 | 53 |
| 2016 September | 7 | 1 | 8 |
| 2016 August | 3 | 1 | 4 |
Show all
