Monday, April 9, 2018

Referrals to Child Neurology: Maximizing the Patient’s Benefit

Dara Albert
Nationwide Children's Hospital

Neurological disorders are common in children and primary care pediatricians will often be the one to decide if referral to a child neurologist is indicated. We aim to review referrals placed by pediatricians to a tertiary care center’s child neurology clinic and attempt to identify which referrals were most likely to lead to direct patient benefit. This may shade light on areas for additional education for pediatricians.

Referrals were collected and sorted into categories by chief complaint. We developed a Patient Benefit score to estimate the referrals’ likelihood of benefit to the patient and this was used to evaluate referrals. A one-way analysis of variance was utilized to identify differences between the groups.

A Patient Benefit score was calculated for 342 referrals. The average Patient Benefit score for all referrals was 3.69 (out of 6 possible points). Only 4 referrals (1%) earned a 0 on the scale, indicating the child was referred to the incorrect specialty for the presenting problem. Less than half of referrals scored high on the scale. The ANOVA showed significant differences between the groups (F=11.78, p=0.000). Referrals ordered for headaches had significantly higher scores, while referrals for abnormal involuntary movements had significantly lower scores than all other groups.

In this study we found that referrals to a tertiary care center’s outpatient child neurology clinic led to a modest benefit to the patient. The data allows us to highlight areas for additional educational interventions for pediatricians. Further education could bolster the ability to triage neurological concerns and prioritize referrals for those children who would most benefit from the expertise of the child neurologist.