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.
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http://dx.doi.org/10.1080/02688697.2020.1853675 | DOI Listing |
PLoS One
January 2025
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
We aimed to determine whether emergency department (ED) overcrowding affects the occurrence of in-hospital cardiac arrest (IHCA) requiring resuscitation in the ED. This retrospective study was conducted in the ED of a single hospital. We applied the propensity score-matching method to adjust for differences in clinical characteristics in patients who visited the ED during overcrowded conditions.
View Article and Find Full Text PDFAsian J Transfus Sci
November 2023
Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
Introduction: Massive hemorrhage calls for massive transfusions (MTs) to maintain adequate hemostasis. Massive transfusion protocols (MTPs) are the appropriate treatment strategy for such patients replacing conventional use of crystalloids. These help in standardizing and optimizing the delivery of blood components in a well-balanced ratio.
View Article and Find Full Text PDFCureus
December 2024
General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, IND.
Objectives The study aimed at estimating the triglyceride glucose (TyG) index in patients with ischemic stroke, exploring the correlation between the TyG index and the prognosis of ischemic stroke, and studying the clinical outcome in patients with acute ischemic stroke (AIS) in association with the TyG index. Methods An observational study was conducted on 105 patients with a history of AIS presenting within 24 hours. The TyG index was estimated, and the clinical outcome was studied.
View Article and Find Full Text PDFGlob Reg Health Technol Assess
December 2024
Department of Hospital Pharmacy, Città della Salute e della Scienza di Torino, Turin - Italy.
Introduction: The infections of multidrug-resistant organisms (MDROs) associated with duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedure have become a significant cause for concern, especially in fragile patients. While the clinical impacts of these infections are well-documented, their economic implications remain underexplored. This study assesses the incidence and economic burden of post-ERCP infections in Italy using an administrative database.
View Article and Find Full Text PDFInt J Gen Med
January 2025
Department of Geriatric Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People's Republic of China.
Objective: We aimed to address the predictive value of urinary kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinases-2 (TIMP-2) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for contrast-induced acute kidney injury (CI-AKI) in elderly patients after percutaneous coronary intervention (PCI).
Methods: One hundred thirty-six patients who underwent PCI were separated into the CI-AKI group (n = 36) and the non-CI-AKI group (n = 100) based on CI-AKI occurrence after operation, and their general data were collected. Blood and urine specimens were collected before operation (at the time of admission) and 6 h, 12 h, 24 h and 48 h after the operation and preserved for future use.
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