An integrated model of care for neurological infections: the first six years of referrals to a specialist service at a university teaching hospital in Northwest England

Abstract

Background: A specialist neurological infectious disease service has been run jointly by the departments of infectious disease and neurology at the Royal Liverpool University Hospital since 2005. We sought to describe the referral case mix and outcomes of the first six years of referrals to the service.

Methods: Retrospective service review.

Results: Of 242 adults referred to the service, 231 (95%) were inpatients. Neurological infections were confirmed in 155 (64%), indicating a high degree of selection before referral. Viral meningitis (35 cases), bacterial meningitis (33) and encephalitis (22) accounted for 38% of referrals and 61% of confirmed neurological infections. Although an infrequent diagnosis (n = 19), neurological TB caused the longest admission (median 23, range 5-119 days). A proven or probable microbiological diagnosis was found in 100/155 cases (64.5%). For the whole cohort, altered sensorium, older age and longer hospital stay were associated with poor outcome (death or neurological disability); viral meningitis was associated with good outcome. In multivariate analysis altered sensorium remained significantly associated with poor outcome, adjusted odds ratio 3.04 (95% confidence interval 1.28-7.22, p = 0.01).

Conclusions: A service of this type provides important specialist care and a focus for training and clinical research on complex neurological infections.

Fig. 1

Final diagnoses made in 242 patients referred with suspected neurological infection. “HIV other” refers to two cases of HIV associated myelopathy, one case of optic neuropathy, one adverse drug reaction to anti-retroviral therapy, one case of cerebral vasculitis and one with Guillain Barré syndrome (the presenting syndrome of HIV infection)