Skip to main content

Advertisement

SpringerLink
Log in

The Italian hub-and-spoke network for the emergency neurology management

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

A Correction to this article was published on 21 June 2023

This article has been updated

Abstract

Objective

The aim of the present study was to assess emergency neurology management in Italy by comparing patients admitted to the hub and spoke hospitals.

Methods

Data obtained from the annual Italian national survey (NEUDay) investigating the activity and facilities of neurology in the emergency room conducted in November 2021 were considered. Information for each patient who received a neurologic consultation after accessing the emergency room was acquired. Data on facilities were also gathered, including hospital classification (hub vs spoke), number of consultations, presence of neurology and stroke unit, number of beds, availability of neurologist, radiologist, neuroradiologist, and instrumental diagnostic accessibility.

Results

Overall, 1,111 patients were admitted to the emergency room and had neurological consultation across 153 facilities (out of the 260 Italian ones). Hub hospitals had significantly more beds, availability of neurological staff, and instrumental diagnostic accessibility. Patients admitted to hub hospital had a greater need for assistance (higher number of yellow/red codes at neurologist triage). A higher propensity to be admitted to hub centers for cerebrovascular problems and to receive a diagnosis of stroke was observed.

Conclusions

The identification of hub and spoke hospitals is strongly characterized by the presence of beds and instrumentation mainly dedicated to acute cerebrovascular pathologies. Moreover, the similarity in the number and type of accesses between hub and spoke hospitals suggests the need to look for adequate identification of all the neurological pathologies requiring urgent treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data can be obtained by contacting the corresponding author upon reasonable request.

Code availability

Statistical analysis was performed using the Statistical Analysis System Software (version 9.4; SAS Institute, Cary, NC, USA). Codes can be obtained by contacting the corresponding author.

Change history

References

  1. Cairns C, Kang K, Santo L. National Hospital Ambulatory Medical Care Survey: 2018 emergency department summary tables. Stroke Vasc Interv Neurol 3(1):e000427. https://doi.org/10.1161/svin.122.000427

  2. GBD 2015 Neurological Disorders Collaborator Group (2017) Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 16:877–897

  3. Gelauff J, Stone J, Edwards M, Carson A (2014) The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 85:220–226

    Article  PubMed  Google Scholar 

  4. Gooch CL, Pracht E, Borenstein AR (2017) The burden of neurological disease in the United States: a summary report and call to action. Ann Neurol 81:479–484

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. Nardetto L, Giometto B, Moretto G, Mantoan D, Saia M (2017) Hub-and-spoke stroke network in the Veneto region: a retrospective study investigating the effectiveness of the stroke pathway and trends over time. Neurol Sci 38:2117–2121

    Article  CAS  PubMed  Google Scholar 

  7. Elrod JK, Fortenberry JL Jr (2017) The hub-and-spoke organization design: an avenue for serving patients well. BMC Health Serv Res 17:457

    Article  PubMed  PubMed Central  Google Scholar 

  8. de Falco FA, Sterzi R, Toso V, Consoli D, Guidetti D, Provinciali L, Leone MA, Beghi E (2008) The neurologist in the emergency department. An Italian nationwide epidemiological survey. Neurol Sci. 29:67–75

    Article  PubMed  Google Scholar 

  9. Micieli G, Cavallini A, Cortelli P, Rea F, Italian NEUday group (2022) Did the role of the neurologist in the emergency department change during the COVID-19 pandemic? Evidence from an Italian nationwide survey. Neurol Sci 43:1513–1520

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chieregato A, Volpi A, Gordini G, Ventura C, Barozzi M, Caspani MLR, Fabbri A, Ferrari AM, Ferri E, Giugni A, Marino M, Martino C, Pizzamiglio M, Ravaldini M, Russo E, Trabucco L, Trombetti S, De Palma R (2017) How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study. BMJ Open 7:e016415

    Article  PubMed  PubMed Central  Google Scholar 

  11. Auld AF, Kamiru H, Azih C, Baughman AL, Nuwagaba-Biribonwoha H, Ehrenkranz P, Agolory S, Sahabo R, Ellerbrock TV, Okello V, Bicego G (2015) Implementation and operational research: evaluation of Swaziland’s hub-and-spoke model for decentralizing access to antiretroviral therapy services. J Acquir Immune Defic Syndr 69:e1-12

    Article  CAS  PubMed  Google Scholar 

  12. Gruppo Intersocietario sulla Neurologia dell’Emergenza-Urgenza. La Neurologia dell’Emergenza-Urgenza. Documento di Consenso. 2009. https://www.mondino.it/wp-content/uploads/2017/04/NEU_5ante-in-neurologia-d27urgenza_00481_01_it.pdf. Accessed 26 May 2023

  13. Decreto del Ministero della Salute. 2 aprile 2015, n.70. https://www.gazzettaufficiale.it/eli/id/2015/06/04/15G00084/sg. Accessed 26 May 2023

  14. Kraft AW, Awad A, Rosenthal JA, Dmytriw AA, Vranic JE, Bonkhoff AK, Bretzner M, Hirsch JA, Rabinov JD, Stapleton CJ, Schwamm LH, Rost NS, Leslie-Mazwi TM, Patel AB, Regenhardt RW (2022) In a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes. Interv Neuroradiol 29(3):315–320. https://doi.org/10.1177/15910199221087498

    Article  PubMed  Google Scholar 

  15. Regenhardt RW, Awad A, Kraft AW, Rosenthal JA, Dmytriw AA, Vranic JE, Bonkhoff AK, Bretzner M, Etherton MR, Hirsch JA, Rabinov JD, Singhal AB, Rost NS, Stapleton CJ, Leslie-Mazwi TM, Patel AB (2022) Characterizing reasons for stroke thrombectomy ineligibility among potential candidates transferred in a hub-and-spoke network. Stroke Vasc Interv Neurol 2:e000282

    PubMed  PubMed Central  Google Scholar 

  16. Rete regionale delle neuroscienze: ulteriori determinazioni in merito alla rete stroke di Regione Lombardia. DELIBERAZIONE N° XI / 7473, 30 November 2022. https://www.regione.lombardia.it/wps/wcm/connect/1a21f9ee-a3f8-4d71-87b5-09c04247a038/DGR_XI_7473_30+novembre_2022.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-1a21f9ee-a3f8-4d71-87b5-09c04247a038-oqSqcol. Accessed 26 May 2023

  17. Micieli G, Cavallini A, Ricci S, Consoli D, Edlow JA (2021) Decision algorithms for emergency neurology. Springer

    Book  Google Scholar 

  18. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Headache, Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ (2019) Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med 74:e41–e74

    Article  Google Scholar 

  19. Demaerschalk BM, Boyd EL, Barrett KM, Gamble DM, Sonchik S, Comer MM, Wieser J, Hentz JGJ, Fitz-Patrick D, Chang YH (2018) Comparison of stroke outcomes of hub and spoke hospital treated patients in Mayo Clinic telestroke program. J Stroke Cerebrovasc Dis 27:2940–2942

    Article  PubMed  Google Scholar 

  20. Mark DG, Huang J, Sonne DC, Rauchwerger AS, Reed ME, Kaiser Permanente CREST Network Investigators (2023) Mortality following diagnosis of nontraumatic intracerebral hemorrhage within an integrated “hub-and-spoke” neuroscience care model: is spoke presentation noninferior to hub presentation? Neurocrit Care. https://doi.org/10.1007/s12028-022-01667-0

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Former Department of Emergency Neurology, IRCCS C. Mondino Foundation, Pavia, Italy

    Giuseppe Micieli

  2. IRCCS Istituto delle Scienze Neurologiche Di Bologna, Bologna, Italy

    Pietro Cortelli

  3. DIBINEM, University of Bologna, Bologna, Italy

    Pietro Cortelli

  4. Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Massimo Del Sette

  5. Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino-IRCCS Policlinico San Matteo, Pavia, Italy

    Anna Cavallini

  6. Neurology and Stroke Unit, ASST Melegnano-Martesana, Vizzolo Predabissi, Milan, Italy

    Carla Zanferrari

  7. Neurology and Stroke Unit, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy

    Arturo De Falco

  8. Dipartimento di Scienze Neurologiche, UOC di Neurologia—Ospedale dell’Angelo, AULSS 3 Serenissima, Venezia Mestre, Italy

    Rocco Quatrale

  9. Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Guarino Maria

  10. SSD Neurophysiology and Movement Disorders, Department of Neuroscience, ARNAS Brotzu, Cagliari, Italy

    Giovanni Cossu

  11. Dipartimento di Neuroscienze, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy

    Shalom Haggiag & Francesca Romana Pezzella

  12. Neurology and Stroke Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Maria Luisa Zedde

  13. National Centre for Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy

    Federico Rea

  14. Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy

    Federico Rea

Authors
  1. Giuseppe Micieli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pietro Cortelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Massimo Del Sette
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Cavallini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carla Zanferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arturo De Falco
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rocco Quatrale
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Guarino Maria
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giovanni Cossu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shalom Haggiag
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Francesca Romana Pezzella
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Maria Luisa Zedde
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Federico Rea
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Italian NEUDay Group

  • Abruzzo e Molise
  • , Puglia e Basilicata
  • ,  Sardegna
  • ,  Calabria
  • ,  Campania
  • ,  Emilia-Romagna
  • , Province Trento e Bolzano
  • ,  Lazio
  • ,  Liguria
  • ,  Lombardia
  • ,  Marche
  • , Piemonte eVal d’Aosta
  • ,  Sicilia
  • ,  Toscana
  • ,  Umbria
  •  &  Veneto

Corresponding author

Correspondence to Giuseppe Micieli.

Ethics declarations

Ethical approval

None.

Informed consent

The project and execution of NEUDay 2021 have been notified to all ethical committees of the participating units.

Conflict of interestl

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The original article contains an error. The Appendix that contains the names listed in the NEUDay Group were added.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17.6 KB)

Appendix

Appendix

*NEUDay group 2021

Abruzzo e Molise: Simona Sacco (Coord.) Marco Onofrj, Maria Vittoria De Angelis (Chieti), Matteo Di Giuseppe, Casalena Alfonsina (Teramo), Simona Sacco, Bernardino Orlandi (Avezzano), Gabriele Lombardozzi, Katia Armellino (Pescara), Francesca Pistoia, Filomena Barbone (L’Aquila), Nicola Iorio, Giovanni Caranci (Campobasso)

Puglia e Basilicata: Bruno Passarella (Coord.) Elisabetta Di Monte, Isabella Pavone (Matera), Antonio Carbone, Angelo Zenzola (Tricase), Filippo Tamma, Antonio Scarafino (Acquaviva delle Fonti), Ardito Bonaventura, Domenico Di Noia (Altamura), Giuseppe Rinaldi, Marco Vito Rossi (Bari), Maurizio Giorelli, Maria Stella Aniello, (Barletta), Vincenza Pinto, Augusto Rini (Brindisi), Ciro Mundi, Tommaso Martino (Foggia), Antonella Mastronardi, Gaetano Barbagallo (Lecce), Cosimo Diroma, Laura Mascolo (Monopoli), Danilo Fogli, Pietro Di Viesti (San Giovanni Rotondo), Giovanni Boero (Taranto).

Sardegna: Maurizio Melis (Coord.), Maria Valeria Saddi, Maria Luigia Piras (Nuoro)

Calabria: Franco Galati (Coord.), Giovanni Maria Franco, Franco Galati (Vibo Valentia)

Campania: Rosa Napoletano (Coord.), Florindo D’Onofrio, Elisabetta Iannaccone (Avellino), Ornella Nori, Luigi Del Gaudio (Castellammare di Stabia), Maria Pia Mazzaferro, Patrizia Ripa (Napoli), Gianpiero Volpe, Anna Silvestro (Vallo della Lucania), Angelo Ranieri, Gennaro Alfieri (Napoli), Guglielmo Capaldo, Marco Massarelli (Adriano Irpino), Leonardo Sinisi, Grazia Sibilia (Napoli)

Emilia-Romagna: Maria Guarino (Coord.), Marco Longoni, Michele Romoli (Cesena), Marco Longoni, Francesca Bianchi (Forlì), Ilaria Naldi, Leonardo Sani (Imola), Marco Mazzoli, Laura Giacobazzi (Modena), Maria Luisa Zedde, Ilaria Grisendi (Reggio Emilia), Rita Rinaldi, Pietro Cortelli (Bologna), Andrea Zini, Federica Naldi (Bologna), Elena Minguzzi, Gemma Bassani (Ravenna), Alessandro Zilioli, Sonia Romano (Parma), Nicola Mometto, Donata Guidetti (Piacenza)

Province Trento e Bolzano: Bruno Giometto (Coord.), Michele Rana, Alessandro Marini (Gorizia), Paolo Passadore, Stefano Novello (Pordenone), Bruno Giometto, Valentina Poretto (Trento),

Lazio: Claudio Gasperini (Coord.) Fabio Pilato, Vincenzo di Lazzaro (Roma), Cinzia Roberti, Carla Gualandi (Roma), Francesca Gragnani, Isabella Ferdinanda Pestalozza (Roma), Alessandro Davoli, Nives Stefani (Roma), Pierluigi Galizia, Laura Di Clemente (Roma), Vanessa Ceschin, Franco Giubilei (Roma), Francesca Muzzi, Angela Pisani (Roma Ostia), Alessandro Davoli, Maria Magarelli (Roma)

Liguria: Massimo del Sette (Coord.), Andrea Assini, Laura Strada (Genova), Tiziana Tassinari, Lorenzo Lombardo (Pietra Ligure), Erica Viani, Chiara De Michelis (Imperia), Davide Sassos, Tiziana Benzi Markushi (Genova), Elisa Giorli, Matteo Grazzini (La Spezia)

Lombardia: Andrea Salmaggi, Carla Zanferrari (Coord.) Leonardo Pantoni, Francesco Mele (Milano) Sara La Gioia, Marcella Vedovello (Bergamo), Luigi Caputi, Rosina Paletta (Crema), Ignazio Michele Santilli, Giuseppina Calabrese (Desio), Maria Sofia Cotelli, Marinella Turla (Esine), Chiara Scaccabarozzi, Davide Sangalli (Lecco), Giorgio Silvestrelli, Daria Valeria Roccatagliata (Mantova), Sara Bonato, Giacomo Comi (Milano), Simone Tonietti, Riccardo Altavilla (Milano), Edoardo Dalmato Schilke, Giulia Regonesi (Monza), Anna Cavallini, Alessandra Persico (Pavia), Luca Nicola Romano, Mauro Roncoroni (Saronno), Sandro Beretta, Massimiliano Braga (Vimercate), Simona Fanucchi, Maria Teresa Sollazzo (Lodi), Mauro Magoni, Nicola Gilberti: (Brescia), Fabrizio Fiacco, Paola Maggio (Seriate), Vincenzo Sidoti, Ubaldo Balducci (Chiari), Elisabetta Domina, Vincenzo Belcastro (Lodi)

Marche: Simona Lattanzi (Coord.), Mauro Silvestrini, Simona Lattanzi (Ancona), Patrizio Cardinali, Maria Cristina Acciarri (Fermo), Claudia Cagnetti, Giulio Papiri (San Benedetto del Tronto)

Piemonte e Val d’Aosta: Paolo Cerrato (Coord.) Federica Nicoletta Sepe, Martina Valente (Alessandria), Delfina Ferrandi, Lucia Testa (Casale), Diego Maria Papurello, Chiara Baima Rughet (Ciriè), Massimo Bonzanino, Marianna Riolo (Moncalieri), Eugenia Rota, Gianluca Bruzzone (Novi Ligure), Carmelo Roberto Labate, Elisabetta Picco (Pinerolo), Monica Reggiani, Salvatore Amarù (Rivoli), Mara Rosso, Maria Roberta Bongioanni (Savigliano), Pietro Pignatta, Emanuela Viglietta (Torino), Andrea Naldi, Roberto Cavallo (Torino), Laura Godi, Roberto Pettinaroli (Borgomanero), Cristoforo Comi, Giacomo Tondo (Vercelli), Roberto Pettinaroli, Laura Gosi (Novara)

Sicilia: Emanuele Caggia (Coord.) Davide Maimone, Eleonora Saracco (Catania), Salvatore Lo Fermo, Giovanni Mostile (Catania), Roberta Baschi, Aurelio Piazza (Palermo), Emanuele Caggia, Anna Carnemolla (Ragusa), Roberto Cammalleri, Paolo Aridon (Palermo), Cristina Dell’Aera, Paolino La Spina (Messina), Rosario Grugno, Domenico Cosenza (Messina)

Toscana: Giovanni Orlandi (Coord.), Maria Lamassa, Patrizia Nencini (Firenze), Roberto Marconi, Simone Gallerini (Grosseto), Alessandro Napolitano, Alberto Chiti (Massa), Renato Galli, Chiara Pecori (Pontedera), Raffaella Valenti, Pasquale Palumbo (Prato), Giovanni Orlandi, Nicola Giannini (Pisa), Rossana Tassi, Ivo Giuseppe De Franco (Siena), Paolo Del Dotto, Elisabetta Molesti (Viareggio), Alessandro Tiezzi, Benedetta Calchetti (Arezzo), Marco Vista, Eva Terni (Lucca), Luciana Tramacere, Valentina Rinnoci (Firenze), Chiara Menichetti, Gino Volpi (Pistoia)

Umbria: Francesco Corea (Coord.) Simone Simoni, Claudio Verderosa (Perugia), Antonella Picchioni, David Giannandrea (Città di Castello e Branca)

Veneto: Paolo Passadore (Coord.) Bruno Marini, Roberta Rudà (Castelfranco Veneto), Giulio Bozzato, Giessica Canal (Feltre), Carlo Borsato, Marco Volpe (Piove di Sacco), Domenico Marco Bonifati, Silvia Vittoria Guidoni (Treviso), Carmine Tamborino, Rocco Quatrale (Venezia Mestre), Cecilia Zivelonghi, Manuel Cappellari (Verona), Antonio Marangi, Alessia Peretti (Vicenza), Alice Favaretto, Andrea De Zanche (Mirano)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Micieli, G., Cortelli, P., Del Sette, M. et al. The Italian hub-and-spoke network for the emergency neurology management. Neurol Sci 44, 3929–3937 (2023). https://doi.org/10.1007/s10072-023-06883-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-023-06883-w

Keywords

Search

Navigation