Çocuk Acil Servisine Başvuran Hastalarda Çocuk Nörolojisi Bilim Dalı Konsültasyonlarının Hasta Yönetimine Katkısı

Abstract

Pediatric emergency departments (PED) are healthcare units where both acute and chronic patients requiring urgent intervention are evaluated using a multidisciplinary approach. The frequency and epidemiology of neurological diseases seen in PED can vary. Our study was a retrospective analysis of 862 patients and 1060 consultations for Pediatric Neurology requested between June 2021 and June 2023 at Hacettepe University İhsan Doğramacı Children's Hospital. Of the admissions, 569 (53.7%) were female, and 491 (46.3%) were male. The average age was 7.74 ± 5.64 years. The distribution of admissions was as follows: 6 (0.6%) in the neonatal period, 197 (18.6%) in the infancy period, 176 (16.6%) in the preschool period, 350 (33%) in the school-age period, and 331 (31.2%) in adolescence. The presentation of admissions was classified as neurological (n= 624, 58.9%) and non-neurological (n= 436, 41.1%), with consultations categorized by acute (n=1004, 94.9%) and chronic (n=54, 5.9%) neurological causes. In 86.3% of admissions (n= 915), neurological signs and symptoms were present, while 13.7% (n=145) presented with non-neurological symptoms. The most common neurological reason for admission was seizures (n= 588, 55.5%). Other frequently observed symptoms included focal neurological signs (n= 83, 7.8%), headache (n= 81, 7.6%), and nonepileptic paroxysmal events (n=69, 6.5%). Among non-neurological symptoms, gastrointestinal system complaints (n=64, 6.4%) and fever (n=59, 5%) were the most common. The presenting complaints of patients without a known neurological disorder showed that in 379 admissions (86.9%), neurological complaints were present, and in 57 admissions (13.1%), they were absent. The most common complaint in this group was seizures (n= 173, 39.7%). Among patients with known neurological diseases, 536 admissions (85.9%) had neurological complaints, while 88 admissions (14.1%) did not. Seizures were the most frequent complaint in this group (n= 415, 66.5%). Neurological examination findings varied according to the admission complaints and diagnoses. Tracheostomy was present in 2.4% of admissions (n= 25), gastrostomy in 3% (n=32), and 3% (n=32) required mechanical ventilator support. The most common reasons for consultations were seizures (n= 670, 63.2%), focal neurological signs (n= 94, 9.4%), and headache (n= 78, 7.4%). The most frequent diagnoses were seizures (n= 642, 60.6%), headache (n= 73, 6.9%), and nonepileptic paroxysmal events (n=67, 6.3%). Laboratory and neuroimaging investigations showed variability. The response time for acute and elective consultations was 1.9 ± 23.16 days (ranging from 0 to 273 days). Of the consultations, 995 (93.9%) were for acute conditions, while 65 (6.1%) were for elective cases. Acute consultations were addressed within the first 24 hours. For 87.5% of the consultations (n= 879), no hospitalization was recommended, while hospitalization was suggested for 126 cases (12.5%). Of those recommended for hospitalization, 88.7% (n=125) stayed in the hospital for more than 73 hours. All patients in the emergency department received follow-up and supportive treatment, with anti-seizure medications being the most commonly administered. Apart from the Division of Pediatric Neurology, the most common consultations were requested from the Ophthalmology Department (n= 108, 10.2%), Pediatric Cardiology (n= 86, 8.1%), and Neurosurgery (n= 93, 8.8%). Recurrent neurological admissions occurred in 586 cases (55.3%), with seizures being the most common reason for admission (n= 431, 40.7%). Recurrent non-neurological complaints were mainly fever (n= 125, 28.7%) and gastrointestinal symptoms (n= 119, 27.3%). Regarding requested consultations, treatment changes were observed in 36.6% of admissions (n= 389). A multidisciplinary approach at the PED involving pediatric neurologists and implementation of institutional guidelines are crucial for the diagnosis, care, and management of patients with diverse neurological presentations.