A prospective evaluation of indications for neurological consultation in the XXXX .

@entity1 @entity16 @entity341
BACKGROUND: Recognizing the diverse presentation of neurological conditions that emergency physicians encounter can be challenging, and management of these @entity1 often requires consultation with a neurologist. Accurate diagnosis is critical in @entity16 because @entity1 outcomes are often dependent on timely treatment. Our primary objective was to ascertain whether consultant neurologists understood the reason for consultation in the @entity341 . METHODS: The authors conducted a prospective study of a non-consecutive sample of 94 @entity1 seen in an academic tertiary care @entity341 ( @entity341 ) who underwent consultation by neurologist over 4 consecutive months. At the time a consult was requested, we independently surveyed the treating @entity341 physician for their differential diagnosis. Neurologists were also queried as to whether there was a clear indication for consultation. We then followed the @entity1 to determine their final diagnosis and outcome. RESULTS: The median age was 57 years (interquartile range 45-78). 45.7 % were male. The clinical reasons for all the consults were 61 % focal symptom, 12 % concern about a specific diagnosis, 9 % radiological finding, 9 % diagnostic ambiguity, and 11 % other. There was no significant difference in the rate of a final neurological diagnosis based on the clinical reason for consult (p = 0.13). In the 17 % of @entity1 for whom the treating neurologist reported a lack of a clear indication for the consultation, 25 % were later admitted to a neurological service, and 69 % ultimately had a neurological diagnosis. CONCLUSIONS: Although @entity1 with @entity16 can have diverse presentations, emergency physicians appear to utilize neurologic consultation appropriately. Additionally, nearly 70 % of @entity1 for whom the consultant did not precisely understand the need for the consultation had neurological diagnoses. Time and resource constraints in the @entity341 create challenges in making correct diagnosis.
