Section of Neurosurgry, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, USA.
Section of Neurosurgry, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, USA.
World Neurosurg. 2022 Feb;158:e283-e286. doi: 10.1016/j.wneu.2021.10.175. Epub 2021 Oct 31.
This study evaluated emergency department (ED) neurosurgical reevaluation rates and their causes. Identifying the most significant reasons that make patients return to the ED for a neurosurgical reevaluation can help implement changes to reduce the economic and medical burden of patient turnover.
All patients undergoing neurosurgical reevaluation at our institution's ED after an initial neurosurgical evaluation were enrolled in a prospective 3-month longitudinal registry. Inclusion criteria were all adult patients 21 years of age or older previously evaluated by neurosurgery at our institution's ED who return within 90 days for a neurosurgical reevaluation.
We found an overall 90-day ED neurosurgical return visit rate of 2.1%. During the study, 34 patients returned to the ED for a neurosurgical reevaluation. Patients returned for a neurosurgical reevaluation at a median of 23.5 days after the initial neurosurgery evaluation. The principal causes for a return visit were altered mental status, headache, and wound infections. Among the returning patients, 59% required hospitalization and 50% required an operation.
To our knowledge, this is the first study to prospectively collect data to estimate the 90-day ED return visit rate for a neurosurgical reevaluation following an initial ED neurosurgical evaluation. Some patients still use the ED to get continued care of their condition despite having access to their primary care physician. Better communication, social worker coordination, and prompt follow-up appointments at the neurosurgical outpatient clinic may reduce return visits.
本研究评估了急诊科（ED）神经外科再评估率及其原因。确定使患者返回 ED 进行神经外科再评估的最重要原因，可以帮助实施改变，以减轻患者周转带来的经济和医疗负担。
在我们机构的 ED 进行初始神经外科评估后，所有在我们机构的 ED 进行神经外科再评估的患者都被纳入一项前瞻性 3 个月纵向登记研究。纳入标准为所有年龄在 21 岁或以上的成年患者，先前在我们机构的 ED 接受过神经外科评估，且在 90 天内因神经外科再评估返回。
我们发现总体 90 天 ED 神经外科复诊率为 2.1%。在研究期间，有 34 名患者因神经外科再评估返回 ED。患者在初次神经外科评估后中位数为 23.5 天返回 ED 进行神经外科再评估。再次就诊的主要原因是精神状态改变、头痛和伤口感染。在返回的患者中，59%需要住院治疗，50%需要手术。
据我们所知，这是第一项前瞻性收集数据以估计初始 ED 神经外科评估后 90 天 ED 神经外科再评估的 90 天 ED 复诊率的研究。尽管患者可以接触到他们的初级保健医生，但仍有一些患者仍使用 ED 来继续治疗他们的病情。更好的沟通、社工协调以及在神经外科门诊及时预约随访可能会减少再次就诊。
