Abstract：
OBJECTIVE: To investigate emergency clinicians\' comfort level in assessing neurological emergencies and to identify opportunities to foster enhanced training of clinical neurology in the emergency room.
METHODS: Internet-based survey.
METHODS: University teaching hospitals and private referral centers.
METHODS: One hundred and ninety-two emergency and critical care specialists and resident trainees (ECC) and 104 neurology specialists and resident trainees (NEUR) in clinical practice.
METHODS: An internet-based survey was distributed via veterinary professional organizations\' listserves and message boards and responses were collected between March and April 2020. ECC completed a survey evaluating stress levels associated with neurological emergencies, confidence with neurological examinations, and neuroanatomical localization. NEUR completed a similar survey to report their perception of their ECC colleagues\' confidence in the assessment of neurological cases. Chi-square and Mann-Whitney U-tests were used to compare categorical responses and confidence scores between groups. P < 0.002 was considered significant.
RESULTS: Fifty-two percent of ECC found neurological emergencies slightly challenging, whereas 85% of NEUR found them moderately to extremely challenging for ECC (P < 0.0001). ECC\'s median self-reported confidence score in performing a neurologic examination on a scale of 0-100 was 75 (interquartile range [IQR], 27), while NEUR reported a median ECC confidence of 44 (IQR, 25; P < 0.0001). Median self-reported ECC confidence in localizing intracranial, spinal, and neuromuscular disease was 67 (IQR, 40), 88 (IQR, 21), and 60 (IQR, 37), respectively, which was significantly higher than median NEUR-reported ECC confidence of 35 (IQR, 38), 51 (IQR, 31), and 18 (IQR, 20), respectively (all P < 0.0001). Following case transfer, 34% of ECC received NEUR feedback in >75% of cases.
CONCLUSIONS: Noticeable discrepancies between ECC and NEUR perceptions of ECC clinical confidence were seen, while no firm evidence of neurophobia could be inferred. Improvements in interdepartmental communication and teaching of clinical neurology may be warranted.
METHODS: Internet-based survey.
METHODS: University teaching hospitals and private referral centers.
METHODS: One hundred and ninety-two emergency and critical care specialists and resident trainees (ECC) and 104 neurology specialists and resident trainees (NEUR) in clinical practice.
METHODS: An internet-based survey was distributed via veterinary professional organizations\' listserves and message boards and responses were collected between March and April 2020. ECC completed a survey evaluating stress levels associated with neurological emergencies, confidence with neurological examinations, and neuroanatomical localization. NEUR completed a similar survey to report their perception of their ECC colleagues\' confidence in the assessment of neurological cases. Chi-square and Mann-Whitney U-tests were used to compare categorical responses and confidence scores between groups. P < 0.002 was considered significant.
RESULTS: Fifty-two percent of ECC found neurological emergencies slightly challenging, whereas 85% of NEUR found them moderately to extremely challenging for ECC (P < 0.0001). ECC\'s median self-reported confidence score in performing a neurologic examination on a scale of 0-100 was 75 (interquartile range [IQR], 27), while NEUR reported a median ECC confidence of 44 (IQR, 25; P < 0.0001). Median self-reported ECC confidence in localizing intracranial, spinal, and neuromuscular disease was 67 (IQR, 40), 88 (IQR, 21), and 60 (IQR, 37), respectively, which was significantly higher than median NEUR-reported ECC confidence of 35 (IQR, 38), 51 (IQR, 31), and 18 (IQR, 20), respectively (all P < 0.0001). Following case transfer, 34% of ECC received NEUR feedback in >75% of cases.
CONCLUSIONS: Noticeable discrepancies between ECC and NEUR perceptions of ECC clinical confidence were seen, while no firm evidence of neurophobia could be inferred. Improvements in interdepartmental communication and teaching of clinical neurology may be warranted.
摘要：
目的：调查急诊临床医生评估神经系统急症的舒适度，并确定在急诊室加强临床神经病学培训的机会。
方法：基于互联网的调查。
方法：大学教学医院和私人转诊中心。
方法：在临床实践中，有一百九十二名急诊和重症监护专家和住院医师（ECC）和104名神经内科专家和住院医师（NEUR）。
方法：通过兽医专业组织发布了一项基于互联网的调查，并在2020年3月至4月之间收集了回复。ECC完成了一项调查，评估与神经系统紧急情况相关的压力水平，对神经系统检查的信心，和神经解剖学定位。NEUR完成了一项类似的调查，以报告他们对ECC同事对神经系统病例评估的信心的看法。卡方和Mann-WhitneyU检验用于比较组间的分类反应和信心得分。P<0.002被认为是显著的。
结果：52%的ECC发现神经系统紧急情况有点挑战性，而85%的NEUR发现它们对ECC具有中等至极端的挑战性(P<0.0001)。在0-100的范围内进行神经系统检查时，ECC的自我报告信心得分中位数为75（四分位距[IQR]，27),而NEUR报告的ECC置信度中位数为44(IQR，25；P<0.0001）。自我报告ECC对颅内定位的信心中位数，脊柱,神经肌肉疾病为67(IQR，40),88(IQR,21),和60(IQR，37),分别,显着高于NEUR报告的ECC置信度中位数35(IQR，38),51(IQR,31),和18（IQR，20),分别(所有P<0.0001)。案件转移后，34%的ECC在>75%的病例中收到NEUR反馈。
结论：发现ECC和NEUR对ECC临床信心的看法存在明显差异，虽然没有确凿的证据可以推断神经恐惧症。可能需要改善部门间的交流和临床神经病学的教学。
方法：基于互联网的调查。
方法：大学教学医院和私人转诊中心。
方法：在临床实践中，有一百九十二名急诊和重症监护专家和住院医师（ECC）和104名神经内科专家和住院医师（NEUR）。
方法：通过兽医专业组织发布了一项基于互联网的调查，并在2020年3月至4月之间收集了回复。ECC完成了一项调查，评估与神经系统紧急情况相关的压力水平，对神经系统检查的信心，和神经解剖学定位。NEUR完成了一项类似的调查，以报告他们对ECC同事对神经系统病例评估的信心的看法。卡方和Mann-WhitneyU检验用于比较组间的分类反应和信心得分。P<0.002被认为是显著的。
结果：52%的ECC发现神经系统紧急情况有点挑战性，而85%的NEUR发现它们对ECC具有中等至极端的挑战性(P<0.0001)。在0-100的范围内进行神经系统检查时，ECC的自我报告信心得分中位数为75（四分位距[IQR]，27),而NEUR报告的ECC置信度中位数为44(IQR，25；P<0.0001）。自我报告ECC对颅内定位的信心中位数，脊柱,神经肌肉疾病为67(IQR，40),88(IQR,21),和60(IQR，37),分别,显着高于NEUR报告的ECC置信度中位数35(IQR，38),51(IQR,31),和18（IQR，20),分别(所有P<0.0001)。案件转移后，34%的ECC在>75%的病例中收到NEUR反馈。
结论：发现ECC和NEUR对ECC临床信心的看法存在明显差异，虽然没有确凿的证据可以推断神经恐惧症。可能需要改善部门间的交流和临床神经病学的教学。
