PEDIATRIC NEUROLOGY CONSULTATIONS IN THE EMERGENCY DEPARTMENT

Objectives: To describe the frequency, demographics and acute outcomes of specialty pediatric neurology consultations in the emergency department (ED) of a large urban academic children's hospital.

Methods: We used prospective, systematic and standardized data collection during the academic year 2005–2006. We analyzed all requests for pediatric neurology consultation in the ED at Children's Hospital Boston. Data was collected on age, gender, diagnosis, day and time of consult, disposition, duration of encounter and acuity.

Results: In first quarter of 2005, there were 333 pediatric neurology consults in the ED. 43.9% of patients were aged 5–15 years. 36.9% of patients were seen between 6pm and 6 am. 46% of patients were admitted to the hospital, of whom 4 out of 5 patients were admitted to the in-patient neurology or epilepsy services. Half the patients seen were previously unknown to neurology services. The most frequent diagnoses were seizures (47.7%) followed by headache (12%) and ataxia (4%). Of the 157 patients with seizures, 30% were new-onset, 35% had complex partial seizures and 4% presented with status epilepticus.

Conclusion: Neurological disease requiring specialist pediatric neurology consultation and management is common in our emergency department. Many patients present outside routine office hours. These data suggest an important role for dedicated neurology services in pediatric emergency departments.