Neurosurgery Hotline System : A Retrospective Analysis of the Past Three Years

Abstract

  Patients showing stroke suggestive symptoms are directly referred to us through a “Neurosurgery Hotline”, in addition to head injuries and seizures without bothering duty doctors. We reviewed this referral system and report here the prevalence and clinical features of the patients.
  The hotline received emergency calls during off-hours between 5 : 30 PM and 8 : 45 AM including weekend and holiday hours. All 546 registered cases during the last 3 years (June 2009 to May 2012) were retrospectively reviewed.
  The 546 patients consisted of 285 male (mean 61.2 years old) and 261 female (68.9 years old) with an overall mean 65.0 years. Some 372 patients (68%) were referred to us properly as neurosurgical patients. Half of these (207 cases) were stroke patients. In total, 355 patients were admitted (262 of 331 ambulance and 92 of 215 walk-in cases). The concordance rates of initial symptoms with an exact stroke (49.9% overall accuracy) was high in speech disturbance (82.1%), paralysis (80.2%), and coma (77.4%) (Odds ratio : 95% confidence interval=5.78 : 3.26-10.24, 5.11 : 1.96-13.2, 3.78 : 1.7-8.38, respectively) but low in headache (23.6%), dizziness/vertigo (12.1%) and faintness/syncope ; (11.1%) (OR : 95%CI=0.21 : 0.12-0.34, 0.12 : 0.043-0.34, 0.12 : 0.02-0.76, respectively). Benign paroxysmal positional vertigo (26), hypertension (22), inflammatory disease (22) and hypoglycemia (10) were representative stroke mimics.
  The shortage of physicians and/or stroke-familiar doctors in rural areas has been a nationwide concern in Japan. In this situation, some neurosurgeons have taken the burden and responsibility upon themselves to triage neurosurgical diseases including stroke presenting with diverse clinical symptoms. Our hotline system worked well as a broad stroke triage.