Faculty of Medicine and Dentistry, Queens University, and Department of Neurology, Royal Victoria Hospital, Belfast, UK.
Postgrad Med J. 2011 Mar;87(1025):166-9. doi: 10.1136/pgmj.2010.106971. Epub 2010 Dec 23.
Healthcare development in the UK has resulted in an increase in neurologists working in district general hospitals.
The aim of the study was to determine the use of a neurologist for inpatient diagnosis and management, and to measure a neurologist's diagnostic reliability in a district general hospital over a 27-month period. Patient data were prospectively recorded. Follow-up was performed independently by two clinicians reviewing the medical notes. Reasons for diagnostic change were determined.
306 inpatients were referred to the neurologist between 1 January 2007 and 31 March 2009 (2% of medical admissions). Mean (SD) age was 49.3 (18.8) years, and the female/male ratio was 1.2:1. Epilepsy and stroke were the most common diagnoses. Diagnostic concordance between referring physician and neurologist ranged from κ score 0.13 (spinal pathology) to 0.83 (central nervous system infection). Neurological opinion resulted in diagnostic change in 38.2% and management change in 88.8%. Only 1.6% of patients remained without a diagnosis, a fourfold improvement from physician referral. After medical records had been reviewed, 3.3% of inpatient diagnoses (10 of 306 patients) changed from the original diagnosis by the neurologist. Specialist investigation helped in revising diagnoses in four of the 10 diagnostic changes.
This study shows that in a district general hospital a neurologist can contribute to inpatient diagnosis and management with minimal diagnostic change over time, suggesting reliability of this service.
英国的医疗保健发展导致在地区综合医院工作的神经科医生人数增加。
本研究的目的是确定神经科医生在住院患者诊断和管理中的使用情况，并在 27 个月的时间内测量神经科医生在地区综合医院的诊断可靠性。前瞻性地记录患者数据。通过两名独立审查病历的临床医生进行随访。确定诊断变更的原因。
2007 年 1 月 1 日至 2009 年 3 月 31 日期间，有 306 名住院患者被转介至神经科医生（占内科住院患者的 2%）。平均（SD）年龄为 49.3（18.8）岁，女性/男性比例为 1.2:1。癫痫和中风是最常见的诊断。参考医师与神经科医师之间的诊断一致性范围从 κ 评分 0.13（脊柱病理学）到 0.83（中枢神经系统感染）。神经科意见导致 38.2%的患者诊断发生变化，88.8%的患者治疗方案发生变化。只有 1.6%的患者仍未确诊，这一比例较医师转诊时的四倍有所改善。在回顾病历后，有 3.3%（306 名患者中的 10 名）的住院患者诊断由神经科医生的原始诊断发生变化。在这 10 次诊断变化中的 4 次中，专科检查有助于修正诊断。
本研究表明，在地区综合医院中，神经科医生可以为住院患者的诊断和管理做出贡献，并且随着时间的推移诊断变化最小，这表明该服务的可靠性。
