Neurological emergencies as causes of accidents

A large number of people throughout Europe are involved in accidents every year. Neurological emergencies as the underlying cause of accidents are poorly investigated. This retrospective chart review study was performed to evaluate the incidence of such events.

We retrospectively screened the records of the database of our physician-staffed emergency medical service for a 2-year period of time for patients involved in accidents suspicious of having had a neurological incident leading to the accident. The admission diagnoses of these records were compared with the final diagnosis as taken from the hospital records. Additional demographical (gender, age, time of accident) and medical (Glasgow Coma Scale, Injury Severity Score, National Advisory Committee on Aeronautics-Score) data were evaluated and analyzed.

A total of 1545 records associated with accidents were screened, identifying 110 (7.1%) cases eligible for analysis. Fifty-four patients had seizure (49.1%), 7 stroke (6.3%) and 2 suffered from intracerebral hemorrhage (1.8%). The admission diagnosis made by the physician was confirmed in 91.8% of the cases. Accidents with concomitant neurological event happened significantly more frequent between 9 and 12 am. No differences were observed in demographic or medical data for patients with acute neurological event prior to the accident.

Neurological emergencies, particularly epilepsy, stroke and intracerebral hemorrhage are causes of accidents which have to be considered more often than expected and happen most frequently in the morning. Other demographical and medical data provide no additional information for emergency medical personnel to specifically identify such patients. Nevertheless, emergency physicians seem to be highly skilled in finding the correct diagnosis.