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Neurological Emergencies in Patients Hospitalized With Nonneurological Illness

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Abstract
Objective: We aimed to present neurological profiles and clinical outcomes of patients with acute neurological symptoms, which developed during hospitalization with nonneurological illness.

Methods: We organized the neurological alert team (NAT), a neurological rapid response team, to manage in-hospital neurological emergencies. In this registry-based study, we analyzed the clinical profiles and outcomes of patients who were consulted to the NAT. We also compared the 3-month mortality of patients with acute neurological symptoms with that of patients without acute neurological symptoms.

Results: Among the 85,507 adult patients, 591 (0.7%) activated the NAT. The most common reason for NAT activation was stroke symptoms (37.6%), followed by seizures (28.6%), and sudden unresponsiveness (24.0%). The most common diagnosis by the NAT neurologists was metabolic encephalopathy (45.5%), followed by ischemic stroke (21.2%) and seizures or status epilepticus (21.0%). Patients with NAT activation had high rates in mortality before hospital discharge (22.5%) and at 3 months (34.7%), transfer to intensive care units (39.6%), and length of hospital stay (43.1 ± 57.1 days). They also had high prevalence of poor functional status (78.1%) and recurrence of neurological symptoms at 3 months (27.2%). In a Cox proportional hazards model, patients with in-hospital neurological emergencies had a hazard ratio of 13.2 in terms of mortality at 3 months (95% confidence interval, 11.5-15.3; P < 0.001).

Conclusions: Occurrence of acute neurological symptoms during hospital admission was associated with high rate of mortality and poor functional status. These results call for enhanced awareness and hospital-wide strategies for managing in-hospital neurological emergencies.
Author(s)
이상암임채만전상범홍상범Bobin ParkHan-Bin LeeHyunjo LeeJun Young ChangJung Hwa LeeSoh Hyun ChoiSuyeon JeongYong Seo Koo
Issued Date
2021
Type
Article
DOI
10.1097/PTS.0000000000000682
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7236
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2402433140&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Neurological%20Emergencies%20in%20Patients%20Hospitalized%20With%20Nonneurological%20Illness&amp;offset=0&amp;pcAvailability=true
Publisher
Journal of Patient Safety
Location
미국
Language
영어
ISSN
1549-8417
Citation Volume
17
Citation Number
8
Citation Start Page
1332
Citation End Page
1340
Appears in Collections:
Medicine > Medicine
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