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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Timing of emergency referrals to neurosurgery

Meeting Abstract

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  • Daniel M. Fountain - University of Cambridge, Addenbrooke’s Hospital, Division of Neurosurgery, Cambridge, United Kingdom
  • Katie Honney - The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, King's Lynn, United Kingdom
  • William Sage - University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Division of Neurosurgery, Cambridge, United Kingdom
  • Alexis Joannides - University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Division of Neurosurgery, Cambridge, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.17.03

doi: 10.3205/17dgnc099, urn:nbn:de:0183-17dgnc0990

Published: June 9, 2017

© 2017 Fountain et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: Given evidence of improved outcomes with management of neurosurgical patients in dedicated units, and the importance of rapid neurosurgical intervention for emergency extra-axial haematomas, we investigated the timings for emergency neurosurgical referrals from a district general hospital (DGH) to a tertiary referral hospital (TRH).

Methods: This retrospective cohort study included all emergency neurosurgery referrals made from a DGH and from other specialties within the TRH over 6 months between 28th February and 31st August 2016. Referrals were identified using an online neurosurgical referral system and patient notes reviewed to establish the timing of imaging, and neurosurgical decisions and interventions. A Wilcoxon rank sum test was performed for pairwise comparisons.

Results: Of the 427 cases, 242 were male (56.7%) with a median age of presentation of 63 years. The vast majority of referrals were made following a CT head (75%). Overall median time from scan completion to a neurosurgical decision was 3.17 hours at the DGH compared to 1.68 hours at the TRH (p<0.0001). There was a significant difference in the median time from diagnostic imaging to transfer of patients either urgently to the ward (DGH 7.50 hours vs. TRH 3.60 hours, p=0.0010), as an emergency to critical care (DGH 5.58 hours vs. TRH 1.25 hours, p=0.0036), or as an emergency to theatre (DGH 5.14 hours vs. TRH 2.07 hours, p=0.0952).

Conclusions: There is evidence of delayed neurosurgical decision making for referrals between the district general hospital and the tertiary referral hospital and disproportionate delays in admission to neuroscience wards or theatre for emergency neurosurgical procedures.