Abstract
In the province of Ferrara, Italy, the urgent neurological consultation (UNC) cases in the population correspond to the resident outpatients who undergo a UNC in the ER of the university hospital of Ferrara (UHFe). Thanks to this health organization a retrospective survey identified 612 UNC cases (range of age 7–102 years, median 67,5 years) in the study period giving a period prevalence rate of 173 per 100,000 (95% CI 159.3–187.3) which increased with age (χ2 for trend = 178.4 p < 0.001). The daily UNC cases (range 0–14, mean = 7.3, 95% CI 7.1–7.5) followed the Poisson distribution (goodness-of-fit test: λ = 7.3, χ2 = 8082, 12 freedom degrees, p > 0.70). The prevalence rate decreased with the distance between the patients’ residence and the UHFe (χ2 for trend = 82.9, p < 0.001). The commonest clinical conditions requiring UNCs were acute cerebrovascular disorders (28%), headache (14%), and vertigo (9%). The hospital admission rate was 32.5% which increased with age (χ2 for trend = 35.8, p < 0.001). The commonest discharge diagnoses of the admitted cases were ischemic stroke (57.3%), epilepsy (7%), TIA (6%), and intraparenchymal hemorrhage (5.5%). Acute cerebrovascular disease accounted for 69% of the discharge diagnoses. The survey showed that the UNCs’ demand was higher than previous Italian data confirming that acute cerebrovascular disease is the most frequent acute neurological condition requiring attention in the ER. It also suggested that the UNCs could be poorly appropriate. These findings would require the healthcare administrators attention.
Similar content being viewed by others
References
Craig J, Patterson V, Rocke L, Jamison J (1997) Accident and emergency neurology: time for a reappraisal? Health Trends 29:89–91
Gòmez Ibànez A, Irimìa P, Martìnez-Vila E (2008) The problem of neurological emergencies and the need for specific neurology. An Sist Sanit Navar 31(Supp 11):7–13
Antonio d FF, Roberto S, Vito T, Domenico C, Donata G, Leandro P, Leone Maurizio A, Ettore B (2008) The neurologist in the emergency department. An Italian Nationwide epidemiological survey. Neurol Sci 29:67–75
Giuseppe M, De Falco Fabrizio A, Domenico C, Domenico I, Roberto S, Gioacchino T, Danilo T (2012) The role of emergency neurology in Italy: outcome of a consensus meeting for a intersociety position. Neurol Sci 33:297–304
Stone K (2009) When second count: tackling neurological emergencies. Lancet Neurol 8:702–703
Larner AJ, Farmer SF (1999) Recent advances: neurology. BMJ 319:362–366
Moulin T, Sablot D, Vidry E, Belahsen F, Berger E, Lemounaud P, Tatu L, Vuillier F, Cosson A, Revenco E, Capellier G, Rumbach L (2003) Impact of emergency room neurologists on patient management and outcome. Eur Neurol 50:207–214
Garcia-Ramos R, Moreno T, Camacho A et al (2003) Anàlisis de la atenciòn neurològica en la urgencia del Hospital Doce de Octubre. Neurologia 18:431–438
Morgenstern LB, Huber JC, Luna-Gonzales H, Saldin KR, Grotta JC, Shaw SG, Knudson L, Frankowski RF (2001) Headache in the emergency department. Headache 41:537–541
Agostoni E, Santoro P, Frigerio R, Frigo M, Beghi E, Ferrarese C (2004) Management of headache in emergency room. Neurol Sci 25(Suppl 3):S187–S189
Martikainen K, Seppa K, Viita P et al (2003) Transient loss of consciousness as reason for admission to primary health care emergency room. Scand J Prim Health Care 21:61–64
Crespi V (2004) Dizzines and vertigo: an epidemiological survey and patient management in the emergency room. Neurol Sci 25(Suppl 1):S24–S25
Hanley D, Hacke W (2005) Critical care and emergency medicine neurology in stroke. Stroke 36:205–207
Warlow C, Humphrey P, Venables G (2002) UK neurologists and the care of adults with acute neurological problems. Clin Med 2:436–439
Barsan WG, Pancioli AM, Conwit RA (2004) Executive summary of the National Institute of Neurological Disorders and Stroke conference on emergency neurologic clinical trials network. Ann Emerg Med 44:407–412
Janca A, Aarli JA, Prilipkol Prilipko L, Dua T, Saxena S, Saraceno B (2006) WHO/WFN survey on neurological services: a worldwide perspective. J Neurol Sci 247:29–34
Carrol C, Zajicek J (2004) Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK. J Neurol Neurosurg Psychiatry 75:406–409
Govoni V, Fallica E, Monetti VC, Guerzoni F, Faggioli R, Casetta I, Granieri E (2008) Incidence of status epilepticus in southern Europe: a population study in the Health District of Ferrara, Italy. Eur Neurol 59:120–126
Daniela R, Livio G (2000) I costi di struttura dei servizi neurologici in Italia. Farmacoeconomia e Percorsi Terapeutici 1(1):19.24
Govoni V, Cesnik E, Casetta I, Tugnoli V, Tola MR, Granieri E (2012) Temporal trend of amyotrophic lateral sclerosis in southern Europe: a population study in the health district of Ferrara, Italy. J Neurol 259:1623–1631
Govoni V, Granieri E, Manconi M, Capone J, Casetta I (2003) Is there a decrease in Guillain-Barré syndrome after bovine ganglioside withdrawal in Italy? A population-based study in the local health district of Ferrara, Italy. J Neurol Sci 216:99–103
Schoenberg BS (1983) Calculating confidence intervals for rates and ratios. Neuroepidemiology 2:257–265
Lilienfeld AM, Lilienfeld DE (1980) Foundations of epidemiology, 2nd edn. Oxford University Press Inc., New York, Oxford
Daniel WW (1991) Biostatistics: a foundation for analysis in the health sciences, 5th edn. John Wiley& Sons Inc., New York
Armitage P (1955) Tests for linear trends in proportions and frequencies. Biometrics 11:375–386
Bamford J, Sandercock P, Warlow C, Jones L, McPherson K et al (1988) A prospective study of acute cerebrovascular disease in the community: the Oxforshire community stroke project. 1 methodology, demography and incident cases of first ever stroke. J Neurol Neurosurg Psychiatr 51:1373–1380
Avitur O (2006) As public expectation for rPA grows, so too do lawsuits: how neurologists can reduce malpractice risks. Neurol Today 6:31-32
Josephson SA, Engstrom JW, Watcher RM (2008) Neurohospitalist: an emerging model of inpatient neurological care. Ann Neurol 63:135–140
Jmenez-Caballero PE (2005) Analysis of the headaches treated in emergency neurology departments. Rev Neurol 40:648–651
Candelise L, Gattinoni M (2007) Bersano a et al on the behalf of the PROSIT study group (2007) stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 369:299–305
Goldstein LB, Matchar DB, Hoff-Lindquist J, Samsa GP, Horner RD (2003) VA stroke study: neurologist care is associated with increased testing but improved outcomes. Neurology 61:792–796
Caplan L (2003) Stroke is best managed by neurologists. Stroke 34:2763
ASSR (2006) I principali dati della sanità. Monitor, Elem Anal Osservazione Sist Salute 16:23
Hanley DF, Hacke W (2004) Critical care and emergency medicine neurology. Stroke 35:365–366
Roberts K, Costelloe D, Hutchinson M, Tubridy N (2007) What difference does a neurologist make in a general hospital? Estimating the impact of neurology consultations on in-patient care. Ir Med Sci 176:211–214
Moeller JJ, Kurniawan J, Gubitz GJ, Ross JA, Bhan V (2008) Diagnostic accuracy of neurological problems in the emergency department. Can J Neurol Sci 35:335–341
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
For this type of study formal consent is not required.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Govoni, V., Della Coletta, E., Fallica, E. et al. The urgent neurological consultation in the population of the province of Ferrara, Italy. Neurol Sci 39, 1253–1259 (2018). https://doi.org/10.1007/s10072-018-3424-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-018-3424-0