ACR Appropriateness Criteria® Syncope

Imaging, Neurological; Kligerman, Seth; Bykowski, Julie; Koweek, Lynne M. Hurwitz; Policeni, Bruno; Ghoshhajra, Brian; Brown, Michael D.; Davis, Andrew M.; Dibble, Elizabeth H.; Johnson, Thomas V.; Khosa, Faisal; Ledbetter, Luke; Leung, Steve W.; Liebeskind, David S; Litmanovich, Diana; Maroules, Christopher D.; Pannell, J. Scott; Villines, Todd C.; Wang, Lily L.; Wann, Samuel; Corey, Amanda S.; Abbara, Suhny

doi:10.1016/j.jacr.2021.02.021

Cited by 4 publications

(1 citation statement)

References 68 publications

(78 reference statements)

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“…Despite this widespread understanding, little guidance is available regarding the diagnostic usefulness of head CT. The American College of Radiology Appropriateness Criteria suggests that in presyncope and syncope, a non‐contrast head CT is usually not appropriate, but this particularly refers to patients in whom there is high suspicion of cardiac etiology 11 and references literature including patients presenting with focal neurologic complaints 12 . Clarifying appropriateness of high‐cost and high‐risk imaging has become a top priority for emergency medicine, making the “Top Five List” of the policy and research agenda identified by the Robert Wood Johnson Foundation 13 …”

Section: Discussionmentioning

confidence: 99%

Head computerized tomography in emergency department evaluation of the geriatric patient with generalized weakness

et al. 2023

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ObjectiveWeakness in older emergency department (ED) patients presents a broad differential. Evaluation of these patients can be challenging, and the efficacy of head computed tomography (CT) imaging is unclear. This study assesses the usefulness of head CT as a diagnostic study of acute generalized weakness in older ED patients.MethodsThis retrospective review of patients aged 65 years and older presenting to 2 community EDs included patients with a chief complaint of generalized weakness who received a head CT. Patients presenting with a focal neurologic complaint, altered mental status, or trauma were excluded. Variables evaluated included additional triage chief complaints, dementia diagnosis, and deficits on physical examination. Primary outcome was acute intracranial finding on head CT. Secondary outcomes included neurology consultation, neurosurgical consultation, and neurosurgical intervention.ResultsOf 247 patients, 3.2% had an acute intracranial abnormality on head CT. Emergent consultations for neurology and neurosurgery occurred for 1.6% and 2.4% of patients, respectively. None required neurosurgical intervention. Patients with objective weakness or focal neurologic deficits on physical examination were more likely to have acute findings on head CT (8.5% vs. 2.0%, odds ratio 4.56, confidence interval 1.10–18.95). Additional characteristics did not predict acute intracranial abnormality or need for emergent consultation.ConclusionFew patients with generalized weakness evaluated with head CT had acutely abnormal intracranial findings. Patients with objective weakness or neurologic deficits were more likely to have acute abnormalities. Although head CT is frequently used to evaluate geriatric weakness, its utility is low, especially in patients with normal physical examinations.

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Section: Discussionmentioning

confidence: 99%

Head computerized tomography in emergency department evaluation of the geriatric patient with generalized weakness

et al. 2023

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Appropriateness and imaging outcomes of ultrasound, CT, and MR in the emergency department: a retrospective analysis from an urban academic center

Francisco,

Altmayer,

Carlesso

et al. 2024

Emerg Radiol

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Effect of self-management of stroke patients on rehabilitation based on patient-reported outcome

Sun¹,

Liu²,

Zhang³

et al. 2022

Front. Neurosci.

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ObjectiveThis study aimed to investigate the effect of self-management behavior on the rehabilitation of stroke patients to lay a theoretical basis for using patient-reported outcome (PRO) for rehabilitation evaluation of stroke patients.Materials and methods396 patients hospitalized in the Department of Neurology of 4 tertiary general hospitals in Datong from August 1st 2018 to March 31st 2020 were included in accordance with the inclusion and exclusion criteria. The included patients were randomly assigned into a self-management intervention group and a control group. Only the control group received the clinical pathway intervention of stroke rehabilitation. The stroke patients in the intervention group received the self-management intervention in addition to the clinical pathway intervention of stroke rehabilitation. The self-management status and rehabilitation results of the patients were evaluated in 24 h and 3 months after the patients were enrolled, respectively. Statistical description and analysis were conducted using SPSS20.0 statistical software. The general data of the patients were expressed by percentage. The data regarding patients’ self-management and rehabilitation results were statistically described by percentage, mean and standard deviation. The comparison between groups was drawn through t-test and analysis of variance. Bonferroni method was used for multiple comparison correction. The correlation between rehabilitation results and patients’ basic conditions and self-management was investigated through Pearson correlation analysis. The main factors for self-management behaviors were studied through multiple stepwise regression analyses.ResultsThe total scores of self-management behaviors of the investigated subjects achieved statistical significance in different ages, occupations, educational levels, income levels, exercise intervention, past medical history, BMI, as well as marital status (P < 0.01). In this study, there was no statistical difference in different genders and medical insurance status (P > 0.05). The total scores of self-management behaviors and the scores of the respective dimension were positively correlated with the health education, exercise intervention, functional training, psychological intervention, food intake, living habits, and functional training of stroke patients at the recovery stage. Educational level and marital status were positively correlated with the rehabilitation results of patients. The PRO questionnaire for the stroke scored higher in married patients and highly educated patients, and there were statistically significant differences (P < 0.01). Family history was negatively correlated with the rehabilitation results of patients. Exercise intervention and functional training were positively correlated with the rehabilitation results of patients.ConclusionEducation level, health education, food intake, exercise and rehabilitation training, sleep, and psychological intervention were the main factors for self-management behavior in stroke patients at the recovery stage. Self-management interventions can effectively increase the health education level of stroke patients, strengthen their self-confidence in disease self-management, facilitate the establishment of effective self-management behavior of patients, and improve their quality of life and subjective well-being. Stroke PRO scale can be used to evaluate the clinical intervention effect of self-management on stroke patients in multiple dimensions, especially evaluating the improvement of subjective mental and psychological state of patients, thus revealing the intervention effect of self-management on stroke patients comprehensively.

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ACR Appropriateness Criteria® Syncope

Cited by 4 publications

References 68 publications

Head computerized tomography in emergency department evaluation of the geriatric patient with generalized weakness

Head computerized tomography in emergency department evaluation of the geriatric patient with generalized weakness

Appropriateness and imaging outcomes of ultrasound, CT, and MR in the emergency department: a retrospective analysis from an urban academic center

Effect of self-management of stroke patients on rehabilitation based on patient-reported outcome

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