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{
    "pk": 1213,
    "title": "A Rare Cause of Headache and an Unorthodox Transfer: A Case Report",
    "subtitle": null,
    "abstract": "Introduction:\n Emergency department (ED) crowding and hospital diversion times are increasing nationwide, with negative effects on patient safety and an association with increased mortality. Crowding in referral centers makes transfer of complex or critical patients by rural emergency physicians (EP) more complicated and difficult. We present a case requiring an unorthodox transfer method to navigate extensive hospital diversion and obtain life-saving neurosurgical care.\nCase Report:\n We present the case of a previously healthy 21-year-old male with two hours of headache and rapid neurologic decompensation en route to and at the ED. Computed tomography revealed obstructive hydrocephalus recognized by the EP, who medically managed the increased intracranial pressure (ICP) and began the transfer process for neurosurgical evaluation and management. After refusal by six referral centers in multiple states, all of which were on diversion, the EP initiated an unorthodox transfer procedure to the institution at which he trained, ultimately transferring the patient by air. Bilateral external ventricular drains were placed in the receiving ED, and the patient ultimately underwent neurosurgical resection of an obstructive colloid cyst.\nConclusion:\n First, our case illustrates the difficulties faced by rural EPs when attempting to transfer critical patients when large referral centers are refusing transfers and the need for improvements in facilitating timely transfers of critically ill, time-sensitive patients. Second, EPs should be aware of colloid cysts as a rare but potentially catastrophic cause of rapid neurologic decline due to increased ICP, and the ED management thereof, which we review.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "boarding"
        },
        {
            "word": "transfer"
        },
        {
            "word": "colloid cyst"
        },
        {
            "word": "intracranial hypertension"
        },
        {
            "word": "case report"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/1f9402n2",
    "frozenauthors": [
        {
            "first_name": "Samuel",
            "middle_name": "L.",
            "last_name": "Burleson",
            "name_suffix": "",
            "institution": "University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama",
            "department": "None"
        },
        {
            "first_name": "Joe",
            "middle_name": "",
            "last_name": "Butler",
            "name_suffix": "",
            "institution": "Baptist Memorial Hospital – Golden Triangle, Department of Emergency Medicine, Columbus, Mississippi",
            "department": "None"
        },
        {
            "first_name": "Gabrielle",
            "middle_name": "",
            "last_name": "Gostigian",
            "name_suffix": "",
            "institution": "University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama",
            "department": "None"
        },
        {
            "first_name": "Matthew",
            "middle_name": "S.",
            "last_name": "Parr",
            "name_suffix": "",
            "institution": "University of Alabama at Birmingham, Department of Neurosurgery, Birmingham, Alabama",
            "department": "None"
        },
        {
            "first_name": "Matthew",
            "middle_name": "P.",
            "last_name": "Kelly",
            "name_suffix": "",
            "institution": "University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama",
            "department": "None"
        }
    ],
    "date_submitted": "2023-01-12T04:40:42Z",
    "date_accepted": "2023-01-12T04:40:42Z",
    "date_published": "2023-01-12T04:45:29Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/1213/galley/950/download/"
        }
    ]
}