Office for Health Improvement and Disparities (OHID), United Kingdom Department of Health and Social Care, London, UK.
Lancaster Medical School, Lancaster University, Lancaster, UK.
BMJ Open. 2022 Nov 4;12(11):e061843. doi: 10.1136/bmjopen-2022-061843.
In this first large-scale analysis of neurological emergency admissions in England, we determine the number and types of emergency admissions with neurological emergency diagnostic codes, how many are under the care of a neurologist or neurosurgeon and how such admissions vary by levels of deprivation.
Retrospective empirical research employing a derived list of neurological emergency diagnostic codes SETTING: This study used the Hospital Episode Statistics data set for the financial year 2019/2020 based on 17 million in-year inpatient admissions in England including 6.5 million (100%) emergency admissions with any diagnosis codes.
There were 1.4 million (21.2%) emergency inpatient admissions with a mention of any neurological code, approx. 248 455 (3.8%) with mention of a specific neurological emergency code from the derived list, and 72 485 (1.1%) included such a code as the primary reason for admission. The highest number of in-year admissions for adults was for epilepsy (145 995), with epilepsy as the primary diagnostic code in 15 945 (10.9%). Acute nerve root/spinal cord syndrome (41 215), head injury (29 235) and subarachnoid haemorrhage (18 505) accounted for the next three highest number of admissions. 3230 (1.4%) in-year emergency hospital admissions with mention of a neurological emergency code were under the care of a neurologist or neurosurgeon, with only 1315 (0.9%) admissions with mention of an epilepsy code under a neurologist. There was significant variation for epilepsy and functional neurological disorders (FNDs) in particular by Index of Multiple Deprivation decile. The association between deprivation and epilepsy and FND was significant with p-values of 2.5e-6 and 1.5e-8, respectively.
This study has identified important findings in relation to the burden of neurological emergency admissions but further work is needed, with greater clinical engagement in diagnostic coding, to better understand the implications for workforce and changes to service delivery needing to be implemented.
在这项针对英国神经科急症入院的首次大规模分析中，我们确定了具有神经科急症诊断代码的急症入院数量和类型，有多少患者由神经科医生或神经外科医生负责治疗，以及此类入院在贫困程度上的差异。
回顾性实证研究，采用衍生的神经科急症诊断代码清单。
本研究使用了 2019-2020 财年的医院入院统计数据，该数据涵盖了英格兰 1700 万例年内住院患者，其中包括 650 万例（100%）有任何诊断代码的急症入院。
有 140 万例（21.2%）急症住院患者提到了任何神经科代码，大约有 248455 例（3.8%）提到了从衍生清单中提到的特定神经科急症代码，72485 例（1.1%）将此类代码作为主要入院原因。成人年内入院人数最多的是癫痫（145995 例），以癫痫为主要诊断代码的有 15945 例（10.9%）。急性神经根/脊髓综合征（41215 例）、头部损伤（29235 例）和蛛网膜下腔出血（18505 例）是接下来三种入院人数最多的疾病。年内有 3230 例（1.4%）提到神经科急症代码的急症住院患者由神经科医生或神经外科医生负责治疗，仅有 1315 例（0.9%）提到癫痫代码的患者由神经科医生负责治疗。癫痫和功能性神经障碍（FND）的贫困程度差异尤其显著。癫痫和 FND 与贫困程度的关联具有统计学意义，p 值分别为 2.5e-6 和 1.5e-8。
本研究确定了与神经科急症入院负担相关的重要发现，但需要进一步研究，需要更多的临床参与诊断编码，以更好地了解对劳动力的影响，并需要实施服务提供的改变。
