Reducing Unnecessary Diagnostic Testing in Pediatric Syncope: A Quality Improvement Initiative

Winder, Melissa; Marietta, Jennifer; Kerr, Lynne M.; Puchalski, Michael D.; Zhang, Chong; Ware, Adam L.; Cowley, Charles R.

doi:10.1007/s00246-021-02567-4

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…Given that syncope is benign in the majority of cases, some serious medical conditions are relatively rare; however, as there is a non-negligible number of cases, the further development and improvement of clinical tools for risk stratification in syncope patients is of particular importance. This approach would reduce unnecessary diagnostics in low-risk patients, which are associated with higher costs for the health care system and health care facilities [ 11 , 59 , 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Syncope and the 6-Month Incidence of Ischemic Stroke, Arrhythmia, Brain Tumor, Epilepsy, and Anxiety Disorder

et al. 2023

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Objectives: the aim of the present study is to investigate the associations between syncope and subsequent diagnoses of brain tumor, cardiac arrhythmia, stroke/transient ischemic attack (TIA), epilepsy, and anxiety disorder in a large outpatient population in Germany. Methods: This retrospective cohort study uses data from the Disease Analyzer database (IQVIA). Adults who received syncope diagnosis from one of 1284 general practices between January 2005 and December 2021 (index date) were included and matched (1:1) to individuals without syncope diagnosis using a propensity score based on age, sex, the number of consultations during the follow-up period (up to 6 months), and defined co-diagnoses documented within 12 months prior to and on the index date. Finally, associations between syncope and subsequent outcome diagnoses were investigated using multivariable logistic regression models. Results: Data related to 64,016 patients with and 64,016 patients without syncope (mean age 54.5 years, 56.5% female) were available. In total, 6.43% of syncope patients and 2.14% of non-syncope patients were diagnosed with one of the five outcome diagnoses within 6 months of the index date. There was a positive and significant association between syncope and incidences of ischemic stroke/TIA (OR = 2.83, 95% CI = 2.41–3.32), arrhythmia (OR = 3.81, 95% CI = 3.44–4.18), brain tumor (OR = 4.24, 95% CI = 2.50–7.19), epilepsy (OR = 5.52, 95% CI = 4.27–7.14), and anxiety disorder (OR = 1.99, 95% CI = 1.79–2.21). Conclusions: Syncope is significantly associated with an increased risk of subsequent ischemic stroke/TIA, cardiac arrhythmia, brain tumor, epilepsy, and anxiety disorder. Nevertheless, the cumulative incidences for all five diagnoses are very low.

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Section: Discussionmentioning

confidence: 99%

Association between Syncope and the 6-Month Incidence of Ischemic Stroke, Arrhythmia, Brain Tumor, Epilepsy, and Anxiety Disorder

et al. 2023

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“…These may result in knowledge gaps with regard to best pediatric practices, partly explaining the increased use of radiographs at these institutions. 45,46,48,59 Radiograph use was highest in hospitals with higher pediatric volumes. This finding differs from the large body of "volumeoutcome" literature suggesting that higher volumes lead to better adherence to guidelines and better outcomes, for both pediatric and adult patients.…”

Section: Discussionmentioning

confidence: 99%

“…The addition of specific skills or exposure to ED-specific clinical practice guidelines in PEM training may also explain some of the variation. 45,46,48 No studies have specifically evaluated the underlying causes of these differences in low-value radiograph use. Our findings suggest that ED setting and physician specialty training warrant further exploration, perhaps through qualitative studies, to inform future interventions.…”

Section: Discussionmentioning

confidence: 99%

Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases

Freire

Diong

Gandhi

et al. 2022

cmajo

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CMAJ OPEN, 10(4) E889"L ow-value care" describes medical interventions that do not have additional benefit when compared with a less costly alternative. 1,2 Decreasing "low-value care" has been identified as a priority to reduce wait times, patient exposure to harm and anxiety, and unnecessary costs. 1,2 Diagnostic imaging is a major contributor to low-value care in the emergency department (ED), [3][4][5] and accounts for 6 of 10 Choosing Wisely recommendations for emergency phys icians in Canada (https://choosingwiselycanada.org/recommendation/ emergency-medicine/). Low-value diagnostic imaging is a particularly important issue for pediatric patients, who are at increased risk of harm because of their increased susceptibility to ionizing radiation 6 and the harms related to unnecessary treatments associated with diagnostic imaging use. 7,8 One particular area for improvement is the use of low-value radiographs for common pediatric conditions that present to the ED. Multiple clinical practice guidelines recommend against routine radiograph use for bronchiolitis, 9-15 asthma, 12,13,16-18 abdominal

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“…These patients are often referred to pediatric cardiology and neurology clinics for recurrent syncopal episodes and many tests are performed on these patients (2,3).…”

Section: Introductionmentioning

confidence: 99%

Transient loss of consciousness: Neurally-mediated syncope, psychogenic syncope or epilepsy? A cross-sectional study

Kayılıoğlu,

Yayıcı Köken

2023

Northwestern Med J

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Aim: This study aimed to define important clinical and laboratory features that may be useful in the differential diagnosis of pediatric patients who presented with temporary loss of consciousness and in whom cardiac causes had been excluded, especially in the differentiation of convulsive syncope and epileptic seizure. Methods: The records of patients presenting with temporary loss of consciousness and in whom cardiac causes had been excluded, were retrospectively evaluated. All patients were grouped according to their diagnosis and the data were evaluated comparatively. Results: Six-hundred-and-twelve patient files were evaluated, and 350 patient files were included in the study. 68.6% of the patients were diagnosed with vasovagal syncope, 13.1% were diagnosed with psychogenic pseudosyncope and 18.2% of the patients were diagnosed with epilepsy. In addition, compared to other subgroups, the patients in the epilepsy group were younger (p

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Reducing Unnecessary Diagnostic Testing in Pediatric Syncope: A Quality Improvement Initiative

Cited by 10 publications

References 20 publications

Association between Syncope and the 6-Month Incidence of Ischemic Stroke, Arrhythmia, Brain Tumor, Epilepsy, and Anxiety Disorder

Association between Syncope and the 6-Month Incidence of Ischemic Stroke, Arrhythmia, Brain Tumor, Epilepsy, and Anxiety Disorder

Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases

Transient loss of consciousness: Neurally-mediated syncope, psychogenic syncope or epilepsy? A cross-sectional study

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