Leeds Institute of Health Science, University of Leeds, UK; Department of Neurology, Leeds Teaching Hospitals NHS Trust, UK.
Leeds Institute of Health Science, University of Leeds, UK.
J Neurol Sci. 2022 Jun 15;437:120251. doi: 10.1016/j.jns.2022.120251. Epub 2022 Apr 6.
Studies of Functional Neurological Disorders (FND) are usually outpatient-based. To inform service development, we aimed to describe patient pathways through healthcare events, and factors affecting risk of emergency department (ED) reattendance, for people presenting acutely with FND.
Acute neurology/stroke teams at a UK city hospital were contacted regularly over 8 months to log FND referrals. Electronic documentation was then reviewed for hospital healthcare events over the preceding 8 years. Patient pathways through healthcare events over time were mapped, and mixed effects logistic regression was performed for risk of ED reattendance within 1 year.
In 8 months, 212 patients presented acutely with an initial referral suggesting FND. 20% had subsequent alternative diagnoses, but 162 patients were classified from documentation review as possible (17%), probable (28%) or definite (55%) FND. In the preceding 8 years, these 162 patients had 563 ED attendances and 1693 inpatient nights with functional symptoms, but only 26% were referred for psychological therapy, only 66% had a documented diagnosis, and care pathways looped around ED. Three better practice pathway steps were each associated with lower risk of subsequent ED reattendance: documented FND diagnosis (OR = 0.32, p = 0.004), referral to clinical psychology (OR = 0.35, p = 0.04) and outpatient neurology follow-up (OR = 0.25, p < 0.001).
People that present acutely to a UK city hospital with FND tend to follow looping pathways through hospital healthcare events, centred around ED, with low rates of documented diagnosis and referral for psychological therapy. When better practice occurs, it is associated with lower risk of ED reattendance.
功能性神经疾病（FND）的研究通常基于门诊。为了提供服务发展信息，我们旨在描述患有 FND 的患者在医疗保健事件中的就诊路径，并确定影响急诊科（ED）再次就诊风险的因素。
在 8 个月的时间里，英国某城市医院的急性神经病/中风团队定期联系，记录 FND 转诊情况。然后，对过去 8 年的医院医疗保健事件的电子文档进行了审查。随着时间的推移，绘制了患者在医疗保健事件中的就诊路径，并对一年内 ED 再次就诊的风险进行了混合效应逻辑回归分析。
在 8 个月内，212 名患者因初始转诊疑似 FND 而急性就诊。20%的患者随后被诊断为其他疾病，但从文档审查中，162 名患者被分类为可能（17%）、可能（28%）或明确（55%）的 FND。在过去的 8 年里，这 162 名患者因功能性症状在 ED 就诊 563 次，住院 1693 晚，但只有 26%的患者被转介接受心理治疗，只有 66%的患者有明确的诊断，且治疗路径在 ED 周围循环。三个更好的实践路径步骤都与 ED 再次就诊的风险降低相关：有明确的 FND 诊断（OR=0.32，p=0.004）、转介至临床心理学（OR=0.35，p=0.04）和门诊神经科随访（OR=0.25，p<0.001）。
在英国某城市医院急性就诊的 FND 患者往往会在以 ED 为中心的医院医疗保健事件中遵循循环就诊路径，且记录诊断和转介心理治疗的比例较低。当更好的实践发生时，ED 再次就诊的风险会降低。
