{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T15:58:22Z","timestamp":1759334302977,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Incarcerated patients with neurological complaints present substantial diagnostic and care-delivery challenges in emergency departments (EDs). We delineate the clinical spectrum, severity, and outcomes among incarcerated patients managed in an ED with an embedded neuro-emergency expert model. Methods: A retrospective observational study of adult ED visits for neurological symptoms was conducted from September 2018 to June 2025 at a government-designated regional emergency center serving multiple correctional facilities. Incarceration was confirmed in the electronic medical record. Extracted variables included demographics, chief complaint, comorbidities, triage and acuity scale, Glasgow Coma Scale (GCS), neuroimaging, ED diagnoses, and outcomes (hospital admission, ICU care, ED\/in-hospital mortality). Results: Sixty-five patients were included (median age 57.0 years [IQR 47.0\u201364.5]; 95% male). Chief complaints were altered mental status (36.9%), hemiparesis (21.5%), and seizures (13.8%). On arrival, 40.0% had GCS \u2264 12, including 23.1% with severe impairment (GCS 3\u20138). Non-contrast head CT was obtained in 95.4% and diffusion-weighted MRI in 38.5%. Frequent diagnoses were psychiatric\/functional neurological disorder (16.9%), metabolic encephalopathy (15.4%), and acute ischemic stroke (12.3%). Serious conditions (stroke, hypoxic brain injury, central nervous system infection, status epilepticus, and neuroleptic malignant syndrome) were diagnosed in 41.5%. Hospital admission occurred in 63.1% (ICU care in 47.7%); in-hospital mortality was 10.8%. Conclusions: ED visits by incarcerated individuals with neurological complaints were often linked to serious diagnoses, ICU use, and mortality, challenging assumptions of exaggeration. Over two in five had stroke, hypoxic brain injury, central nervous system infection, or status epilepticus. The findings support rapid, systematic, bias-aware evaluation with early neurological involvement, clear imaging triggers, safety protocol, and expedited transfers from correctional facilities.<\/jats:p>","DOI":"10.3390\/brainsci15101069","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T14:16:29Z","timestamp":1759241789000},"page":"1069","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neurological Emergencies in Incarcerated Patients: Clinical Characteristics, Severity, and Outcomes in an Emergency Department with an Embedded Neuro-Emergency Expert Model"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7365-674X","authenticated-orcid":false,"given":"Byung Joon","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5593-5562","authenticated-orcid":false,"given":"Jin Hyouk","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1893-826X","authenticated-orcid":false,"given":"Won Soek","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7286-1449","authenticated-orcid":false,"given":"Young Sun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2651-1023","authenticated-orcid":false,"given":"Sang Ook","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1001\/jamaneurol.2022.4531","article-title":"Prevalence of Neurological Complaints in US Emergency Departments, 2016\u20132019","volume":"80","author":"Liberman","year":"2023","journal-title":"JAMA Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"654","DOI":"10.5811\/WESTJEM.59057","article-title":"Addressing Emergency Department Care for Patients Experiencing Incarceration: A Narrative Review","volume":"24","author":"Armstrong","year":"2023","journal-title":"West J. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S0140-6736(10)61053-7","article-title":"The Health of Prisoners","volume":"377","author":"Fazel","year":"2011","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e250","DOI":"10.1016\/S2468-2667(24)00023-9","article-title":"Mental and Physical Health Morbidity among People in Prisons: An Umbrella Review","volume":"9","author":"Favril","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2021033","DOI":"10.4178\/epih.e2021033","article-title":"Health Inequalities of 57,541 Prisoners in Korea: A Comparison with the General Population","volume":"43","author":"Yoon","year":"2021","journal-title":"Epidemiol. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/acem.14263","article-title":"Functional Neurological Disorder in the Emergency Department","volume":"28","author":"Finkelstein","year":"2021","journal-title":"Acad. Emerg. Med."},{"key":"ref_7","unstructured":"World Health Organization (2025, August 01). Global Tuberculosis Report 2023: Tuberculosis in Prisons. Available online: https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2023\/featured-topics\/tb-in-prisons."},{"key":"ref_8","unstructured":"World Prison Brief (2025, August 01). Republic of Korea\u2014Female Prisoners as Percentage of Prison Population (2023). Available online: https:\/\/www.prisonstudies.org\/country\/republic-south-korea."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"278","DOI":"10.15585\/mmwr.mm7211a2","article-title":"Emergency Department Visits by Incarcerated Adults for Nonfatal Injuries\u2014United States, 2010\u20132019","volume":"72","author":"Wulz","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Jung, Y.W., Ha, S.O., Kim, J.H., Yang, W.S., and Park, Y.S. (2021). Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189461"},{"key":"ref_11","first-page":"436","article-title":"Validation of the Korean Triage and Acuity Scale Compare to Triage by Emergency Severity Index for Emergency Adult Patient: Preliminary Study in a Tertiary Hospital Emergency Medical Center","volume":"27","author":"Kim","year":"2016","journal-title":"J. Korean Soc. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.seizure.2022.04.009","article-title":"Audit of epilepsy healthcare provision in a large UK category B prison","volume":"99","author":"Thomasson","year":"2022","journal-title":"Seizure"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"666","DOI":"10.2105\/AJPH.2008.144279","article-title":"The Health and Health Care of US Prisoners: Results of a Nationwide Survey","volume":"99","author":"Wilper","year":"2009","journal-title":"Am. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Young, J.D., and Badowski, M.E. (2017). Telehealth: Increasing Access to High-Quality Care by Expanding the Role of Technology in Correctional Medicine. J. Clin. Med., 6.","DOI":"10.3390\/jcm6020020"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.2105\/AJPH.2015.302903","article-title":"Implicit Racial\/Ethnic Bias among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review","volume":"105","author":"Hall","year":"2015","journal-title":"Am. J. Public Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/epirev\/mxx018","article-title":"Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis","volume":"40","author":"Kinner","year":"2018","journal-title":"Epidemiol. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1146\/annurev-publhealth-031811-124614","article-title":"Public Health and the Epidemic of Incarceration","volume":"33","author":"Dumont","year":"2012","journal-title":"Annu. Rev. Public Health"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/10\/1069\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T14:33:50Z","timestamp":1759242830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/10\/1069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":17,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["brainsci15101069"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15101069","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}