A retrospective analysis of emergency referrals and admissions to a regional neurosurgical centre 2016-2018
| Autor: | R J Spencer, E. J. St. George, S Amer |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Referral Traumatic brain injury Neurosurgery Cauda equina syndrome Neurosurgical Procedures 03 medical and health sciences 0302 clinical medicine medicine Retrospective analysis Humans Referral and Consultation Retrospective Studies business.industry Workload General Medicine medicine.disease Hydrocephalus Hospitalization 030220 oncology & carcinogenesis Emergency medicine Surgery Neurology (clinical) Major Diagnostic Category business 030217 neurology & neurosurgery |
| Zdroj: | British journal of neurosurgery. 35(4) |
| ISSN: | 1360-046X |
| Popis: | Background and objectives Emergencies account for 60% of UK neurosurgical workload. We analysed the emergency referrals made to the on-call neurosurgical registrar in a regional centre over three years, aiming to identify temporal trends in volume of referrals, admission practices and major diagnostic categories contributing to referrals and admissions. Methods Individual referrals recorded in on-call databases were processed to extract basic demographics, call timing, diagnosis category and whether the patient was admitted under neurosurgery. Linear regression analysis was used to identify temporal trends across the three years. Results A total of 18128 calls were made to the on-call registrar between 2016 and 2018, with a significant increase in monthly calls. On average, one call was received every 88 minutes. An increasing proportion of these calls were taken out of office hours. Diagnostic categories accounting for the largest percentage of calls were traumatic brain injury (17.7%) and cauda equina syndrome (13%). Significant increases in referral volume were seen in cauda equina syndrome, traumatic brain injury, spinal trauma and spinal tumours, while no category had a significant decrease. The admission rate was 17.1% - no change was seen in this across the study period, resulting in increasing numbers of admissions, reflecting increasing referrals. Categories most likely to result in admission were hydrocephalus (41.1%), spontaneous subarachnoid haemorrhage (39.4%), intracranial infection (32.6%) and chronic subdural haematoma (CSDH, 32.2%). A change in admission rate was seen only for CSDH, with a significant increase in the percentage of referrals across the study period. Conclusion Emergency neurosurgical referrals continue to rise in the UK at a rate exceeding population growth. This implies a decreasing referral threshold. However, the constant admission rate suggests either an increasing amount of neurosurgical pathology, the threshold for admission/intervention has decreased, or a combination. Neurosurgical services need to adapt in order to meet increasing demands. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|