Artikel
Timing of emergency referrals to neurosurgery
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Veröffentlicht: | 9. Juni 2017 |
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Objectives: Given evidence of improved outcomes with management of neurosurgical patients in dedicated units, and the importance of rapid neurosurgical intervention for emergency extra-axial haematomas, we investigated the timings for emergency neurosurgical referrals from a district general hospital (DGH) to a tertiary referral hospital (TRH).
Methods: This retrospective cohort study included all emergency neurosurgery referrals made from a DGH and from other specialties within the TRH over 6 months between 28th February and 31st August 2016. Referrals were identified using an online neurosurgical referral system and patient notes reviewed to establish the timing of imaging, and neurosurgical decisions and interventions. A Wilcoxon rank sum test was performed for pairwise comparisons.
Results: Of the 427 cases, 242 were male (56.7%) with a median age of presentation of 63 years. The vast majority of referrals were made following a CT head (75%). Overall median time from scan completion to a neurosurgical decision was 3.17 hours at the DGH compared to 1.68 hours at the TRH (p<0.0001). There was a significant difference in the median time from diagnostic imaging to transfer of patients either urgently to the ward (DGH 7.50 hours vs. TRH 3.60 hours, p=0.0010), as an emergency to critical care (DGH 5.58 hours vs. TRH 1.25 hours, p=0.0036), or as an emergency to theatre (DGH 5.14 hours vs. TRH 2.07 hours, p=0.0952).
Conclusions: There is evidence of delayed neurosurgical decision making for referrals between the district general hospital and the tertiary referral hospital and disproportionate delays in admission to neuroscience wards or theatre for emergency neurosurgical procedures.