Clinical Profile of Neurosurgical Consultations from the Emergency Department : A Retrospective Analysis.

Abstract

Objective: This study aimed to retrospectively analyze consultations requested from the emergency departments (EDs) to the neurosurgery (NS) department of a tertiary care hospital, and to comprehensively evaluate the clinical characteristics, referral reasons, and diagnostic and therapeutic processes of these patients. In addition, the study aims to provide concrete recommendations for strategic objectives such as optimizing hospital workflow, enhancing interphysician coordination, and standardizing consultation processes.

Methods: This single-center, retrospective study evaluated patients who presented to the ED of a tertiary care hospital and for whom a neurosurgical consultation was requested between January 1, 2024 and December 31, 2024. Demographic data, consultation request notes prepared by emergency physicians, consultation responses provided by NS specialists, and radiological imaging findings of the patients were reviewed in detail.

Results: Of the patients, 69% were consulted for traumatic and 31% for non-traumatic reasons. Among traumatic cases, falls were identified as the most common cause, whereas headache and altered mental status were the leading reasons in non-traumatic cases. Of the 386 patients, did not require neurosurgical intervention and were safely directed to clinical follow-up, representing the majority of NS consultations (44.8%). Surgical intervention was performed in 40 of 386 patients (10.3%). The frequency of consultations was notably higher during the summer months.

Conclusion: The increase in admissions during the summer months demonstrates the necessity of planning adapted to seasonal workload. In pediatric head trauma, the application of the Pediatric Emergency Care Applied Research Network rules, and in suspected cauda equina syndrome, performing joint history-taking and physical examination, may enhance diagnostic accuracy and reduce unnecessary imaging. In cases of spontaneous subarachnoid hemorrhage and spontaneous intracerebral hemorrhage, rapid access can be strengthened through telemedicine, artificial intelligence-assisted analysis, and joint educational meetings.