Numbers and types of neurological emergencies in England and the influence of socioeconomic deprivation: 2022 Jackson et al

It's worth having a look at this chart I think - Figure 2. The descriptions throughout the paper are often not particularly clear, but this is my take:



So - the x axis is populations separated into deciles by deprivation, from most deprived on the left to least deprived on the right.

The y axis is the proportion of all the people with hospital emergency admissions during the year who were labelled with the relevant code - that might have been the primary diagnosis or just a co-morbidity. I think the data for this particular chart counts codes applied by the various consultants during the hospital stays, not just the consultant who makes the admission decision.

So, for example, the blue dotted line is for all people who had a neurological emergency code, and shows the percentage of the total number of those people who are in each deprivation decile. Nearly 15% of the people who were admitted and had a neurological emergency code included on their chart were from the most deprived decile.

Look at the huge disparity in the percentages for epilepsy and FNDs across the deprivation deciles. Nearly 20% (910) of people with hospital admissions during the year who had an FND on their chart came from the most deprived decile, while only 5% (220) came from the least deprived decile. Reasons? - it's hard not to conclude that at least part of it is that the people from the most deprived backgrounds are not getting the same level of diagnostic care as the people from more privileged backgrounds. Perhaps too, like the epilepsy rates, this is reflective of a higher incidence of head injury and infections.

It's worth pointing out that the counts for FNDs are only 3% of the total counts (4,680 people out of 162,445 people with the neurological emergency codes selected in this paper*). If you bear in mind that this is including people who might just have an FND on their chart as a co-morbidity and were at hospital for treatment of something like a broken arm, and then there's the people labelled with an FND who turn out to have something known (such as Creutzfeldt-Jacob disease as illustrated in case studies we have looked at recently), then it's especially clear that people with FNDs are not clogging up hospital emergency rooms in vast numbers. Despite that, the paper makes a fairly big deal of FNDs, suggesting several times that it might be possible to make savings and reduce workloads and give people more appropriate care by dealing with people with FNDs using better pathways. The paper does a particularly bad job of keeping the issue of FNDs in proper perspective.


* I've made these calculations using the data in Supplementary table 2. Table 2 in the paper reports different totals - these are for separate admissions - 6454 admissions of people with FND anywhere in their charts, with 1950 having FND as the primary diagnosis on their starting episode.

It does look as though it would be possible to track people with an FND diagnosis (or for that matter CFS) over time using this data, to get some idea of misdiagnosis rates.

 

It might be interesting to do the same sort of analysis for other reasons for emergency care, for example severe asthma attacks, fractures and heart attacks. It seems likely to me that these might form similar patterns of higher prevalence from more deprived areas.

 

Just to put that FND number in perspective - 1950 admissions of people with FND as the primary diagnosis, or even the 6454 admissions of people with FND anywhere on their charts who might just have had an FND as a comorbidity versus

So "FNDs" account for around 0.03% of emergency admissions.