Neurological/neurosurgical referrals overseas from the Queen Elizabeth Hospital, Barbados, 1987 - 1996

ABSTRACT

In 1988, we reported on the neurological/neurosurgical referrals overseas in the period January 1984 to November 1987. The present study is a follow-up of the previous one and reviews overseas referrals over a 9 years period from November 1987 to November 1996. The pattern of referral, diagnoses, referral centres and costs were studied. All Queen Elizabeth Hospital patients transferred overseas between November 1987 and November 1996 under a government-aided scheme for neurological investigation or neurosurgical treatment were include. The Department of Social Services files were reviewed. No patients were transferred in November and December 1987 but 203 patient-transfers were arranged for neurological investigation and/or treatment overseas between January 1988 and November 1996. This includes 10 patients who were transferred twice and one patient three times. 191 patients, 69 males and 122 females, were included, with ages ranging from 1 to 80 (mean 37) years. Most patients were referred to Brooklyn Hospital, New York in 1988, Mount Sinai Medical Center (1989 - 94), and Hospital de Clinicas Caracas, Venezuela (1992 - 96). Twenty overseas centres were used during the study period. Sixty-five percent were referred for neurological management while 48 (25 percent) had MRI scans for diagnosis. The largest diagnostic category was central nervous system tumours (40 percent) followed by subarachnoid haemorrhage (25 percent). Through the government-aided scheme more than ten million BDS dollars were pledged during the study period. Actual costs were determined in only 38 percent of cases but there was a suggestion that the mean actual cost per patient of overseas neurosurgical management and investigation had shown little change over the nine years of the study, remaining at about Bds. $60,000.00(AU)