Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study. Reply to a letter

Dear Editor:

We have read with great attention the comments by Matías-Guiu et al.¹ about our article on the workload of on-call emergency neurologists at Hospital Gregorio Marañón, in Madrid, and we thank the authors for their interest. At our hospital, the neurology team was called to 3.5% of all medical emergencies taking place between August 2010 and July 2011. Matías-Guiu et al. stress that the percentage of neurological diseases treated in emergency departments may be greater if we consider patients who are not assessed by the on-call neurologist. Examples offered by these authors include patients treated for headache or epilepsy at the emergency department of a tertiary care university hospital in which neurologists were consulted in 28% and 55% of these cases, respectively.

We agree with this observation. In a study carried out in the neurology departments in our hospital's healthcare district, on-call neurologists were contacted to help manage only 41% of the patients referred by the emergency department; this percentage was especially low for headache cases (20.4%).² This is probably due to the fact that patients whose main reason for consultation is headache will initially be assessed by the department of internal medicine. This is not the case for patients with epilepsy, the second most frequent disease in our study at 16.17%: these patients are either initially assessed by the neurology department or referred to the neurology department by another department. This shows that the criteria for emergency assessment by a neurologist vary from one hospital to another.

Our study evaluated only the workload of on-call neurologists and therefore did not analyse the prevalence of neurological emergencies. However, exploring that topic may be very useful to improve the planning and management of healthcare resources.

Interest in the management of neurological patients in emergency departments is growing.³ Neurology consults ordered by the emergency department are not only more frequent^4,5 but also more technically complex due to advances in neuroimaging and the implementation of advanced treatments for acute stroke care.⁶ These data underscore the importance of providing hospitals with the technical and human resources necessary to meet current needs.