Introduction: Cardiology and cardiothoracic surgery are among the specialties that most commonly require neurology inpatient consultations. We aimed to study the neurology referrals by the cardiovascular-specialized hospital included in our tertiary hospital center. Methods: Retrospective study of consecutive patients referred for neurology inpatient consultation between January 1, 2020, and December 31, 2022. We analyzed referrals, patients’ characteristics, and the approach taken. A detailed subanalysis was performed for patients diagnosed with acute ischemic stroke (AIS). Results: 143 patients were observed (mean age 67.3 years, 46 [32.2%] females). Most frequent referral reasons were suspected AIS deficits (39.2%), altered mental status (19.6%), suspected seizures (13.3%), and neuroprognostication (11.9%). Mean referral-to-consult time was 2.7 days, and 117 (81.8%) consults were in-person. Additional investigation, treatment changes, and outpatient clinic referral were proposed, respectively, in 79.7%, 60.1%, and 19.6% of patients. Most common diagnoses were AIS (45.5%), hypoxic-ischemic encephalopathy (18.9%), and delirium (7.0%). Regarding patients with AIS (n = 62), most common stroke causes were post-cardiac procedure (44.6%), infective endocarditis (18.5%), aortic dissection (10.8%), acute myocardial infarction (10.8%), and anticoagulant withdrawal in patients with atrial fibrillation (6.2%). Thirty-four AIS patients were diagnosed less than 24 h since last seen well, of which four (6.2%) were treated (three with thrombolysis and one with mechanical thrombectomy). Conclusion: AIS is the most common reason for referral in our cardiovascular hospital. Our results highlight the importance of the availability of a neurologist/neurohospitalist with stroke expertise for consultation of inpatients admitted in a specialized cardiovascular hospital.

1.
Josephson
SA
,
Engstrom
JW
,
Wachter
RM
.
Neurohospitalists: an emerging model for inpatient neurological care
.
Ann Neurol
.
2008
;
63
(
2
):
135
40
. .
2.
Freeman
WD
,
Josephson
SA
.
The birth of neurohospitalists
.
Neurohospitalist
.
2011
;
1
(
1
):
5
7
. .
3.
Steiger
MJ
,
Enevoldson
TP
,
Hammans
SR
,
Ginsberg
L
.
Influence of obtaining a neurological opinion on the diagnosis and management of hospital inpatients
.
J Neurol Neurosurg Psychiatry
.
1996
;
61
(
6
):
653
4
. .
4.
Barrero Hernández
F
,
Muñuzuri Sanz
D
,
Casado Torres
A
.
Estudio descriptivo de las interconsultas intrahospitalarias a un servicio de Neurología
.
Rev Neurol
.
2003
;
36
(
11
):
1001
. .
5.
Costello
DJ
,
Renganathan
R
,
O’Hare
A
,
Murray
B
,
Lynch
T
.
Audit of an inpatient neurology consultation service in a tertiary referral centre: value of the consulting neurologist
.
Ir Med J
.
2005
;
98
(
5
):
134
7
.
6.
Costelloe
L
,
O’Rourke
D
,
Monaghan
TS
,
McCarthy
AJ
,
McCormack
R
,
Kinsella
JA
, et al
.
Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care
.
Ir J Med Sci
.
2011
;
180
(
2
):
395
9
. .
7.
Roberts
K
,
Costelloe
D
,
Hutchinson
M
,
Tubridy
N
.
What difference does a neurologist make in a general hospital? Estimating the impact of neurology consultations on in-patient care
.
Ir J Med Sci
.
2007
;
176
(
3
):
211
4
. .
8.
Rocha
H
,
Monteiro
A
,
Gomes
T
,
Grilo
M
,
Carvalho
M
.
A neurologist’s hard day’s work: impact of inpatient neurology consultation in a tertiary hospital
.
Acta Med Port
.
2016
;
29
(
1
):
46
51
. .
9.
Douglas
M
,
Peake
D
,
Sturman
S
,
Sivaguru
A
,
Clarke
C
,
Nicholl
D
.
The inpatient neurology consultation service: value and cost
.
Clin Med
.
2011
;
11
(
3
):
215
7
. .
10.
Corrêa
KM
,
de Rezende Filho
FM
,
Abrantes
FF
,
de Andrade
JBC
,
Barsottini
OGP
,
Pedroso
JL
.
Clinical and epidemiological characterization of neurological consults: when a neurological evaluation is requested
.
Neurohospitalist
.
2021
;
11
(
2
):
114
8
. .
11.
Hillen
ME
,
Sage
JI
.
Proving the worth of neurologists
.
Neurology
.
1996
;
46
(
1
):
276
7
. .
12.
Aller-Alvarez
JS
,
Quintana
M
,
Santamarina
E
,
Álvarez-Sabín
J
.
Descriptive analysis of neurological in-hospital consultations in a tertiary hospital
.
Neurologia
.
2017
;
32
(
3
):
152
7
. .
13.
McDonagh
DL
,
Berger
M
,
Mathew
JP
,
Graffagnino
C
,
Milano
CA
,
Newman
MF
.
Neurological complications of cardiac surgery
.
Lancet Neurol
.
2014
;
13
(
5
):
490
502
. .
14.
McKhann
GM
,
Grega
MA
,
Borowicz
LM
Jr
,
Baumgartner
WA
,
Selnes
OA
.
Stroke and encephalopathy after cardiac surgery: an update
.
Stroke
.
2006
;
37
(
2
):
562
71
. .
15.
Gilbey
T
,
Milne
B
,
de Somer
F
,
Kunst
G
.
Neurologic complications after cardiopulmonary bypass: a narrative review
.
Perfusion
.
2022
;
38
(
8
):
1545
1559
. .
16.
Probasco
J
,
Sahin
B
,
Tran
T
,
Chung
TH
,
Rosenthal
LS
,
Mari
Z
, et al
.
The preoperative neurological evaluation
.
Neurohospitalist
.
2013
;
3
(
4
):
209
20
. .
17.
Hrdlicka
CM
,
Wang
J
,
Selim
M
.
Neurological complications of cardiac procedures
.
Semin Neurol
.
2021
;
41
(
4
):
398
410
. .
18.
Cronberg
T
,
Greer
DM
,
Lilja
G
,
Moulaert
V
,
Swindell
P
,
Rossetti
AO
.
Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation
.
Lancet Neurol
.
2020
;
19
(
7
):
611
22
. .
19.
Nolan
JP
,
Sandroni
C
,
Böttiger
BW
,
Cariou
A
,
Cronberg
T
,
Friberg
H
, et al
.
European resuscitation council and European society of intensive care medicine guidelines 2021: post-resuscitation care
.
Intens Care Med
.
2021
;
47
(
4
):
369
421
. .
20.
Probasco
JC
,
George
BP
,
Dorsey
ER
,
Venkatesan
A
.
Neurohospitalists: perceived need and training requirements in academic neurology
.
Neurohospitalist
.
2014
;
4
(
1
):
9
17
. .
21.
Donnelly
J
,
Palm
M
,
Brey
R
,
Carver
D
.
How to build a residency training track for future Neurohospitalists: an AAN survey (1407)
.
Neurology
.
2021
;
96
(
15_Suppl
):
1407
. .
22.
Bodilsen
J
,
Nielsen
PB
,
Søgaard
M
,
Dalager-Pedersen
M
,
Speiser
LOZ
,
Yndigegn
T
, et al
.
Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study
.
BMJ
.
2021
;
373
:
n1135
. .
23.
Calvão
J
,
Amador
AF
,
Costa
CMD
,
Araújo
PM
,
Pinho
T
,
Freitas
J
, et al
.
The impact of the COVID-19 pandemic on acute coronary syndrome admissions to a tertiary care hospital in Portugal
.
Rev Port Cardiol
.
2022
;
41
(
2
):
147
52
. .
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