Abstract P298: Redundant Imaging in TIA: Evidence From the Nationwide Emergency Department Sample (NEDS)

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Vincent M Timpone ◽  
Alexandria Jensen ◽  
Sharon N Poisson ◽  
Matthew Salzberg ◽  
Margaret Reid ◽  
...  
Keyword(s):  
Emergency Department ◽  
Brain Mri ◽  
Multivariable Logistic Regression Analysis ◽  
The Past ◽  
The Us ◽  
Imaging Utilization ◽  
Redundant Imaging ◽  
Additional Charges ◽  
Neurovascular Imaging ◽  
Work Up

Introduction: Multiple societal guidelines recommend patients with TIA be emergently imaged with brain-MRI and neurovascular screening-CTA, MRA or carotid ultrasound-to identify and treat risk factors for future stroke. Increased ED compliance with TIA imaging guidelines has previously been demonstrated, along with a substantial increase in imaging utilization over the past decade. The purpose of this study was to quantify prevalence of redundant imaging during ED work-up of TIA, and to identify imaging practices that could be targeted to reduce unnecessary expenditures. Methods: Utilizing the 2006-2017 Nationwide Emergency Department Sample, patients discharged with TIA from EDs in the US were identified using ICD-9/10 codes. Brain and neurovascular imaging obtained during the encounter was identified using CPT codes. Demographics, payor, patient income, and hospital characteristics were incorporated into a hierarchical multivariable logistic regression analysis to identify significant associations with redundant neuroimaging. Results: In 2017 there were 184,870 patients discharged from EDs with TIA. Redundant brain, brain vascular, and cervical vascular imaging was identified in 55,513(30%), 5,149(2.8%) and 1,325(0.7%) of encounters respectively. Decreased odds of obtaining redundant neuroimaging in a TIA encounter was observed in Medicaid patients(OR:0.72, 95%CI:0.64-0.81), non-trauma centers(OR:0.49, 95%CI:0.26-0.93), rural hospital locations(OR:0.18, 95%CI:0.11-0.29) and weekend encounters(OR:0.9, 95%CI:0.85-0.96). Trend analysis from 2006 to 2017 demonstrated a rise in redundant brain and neurovascular imaging from 2.3% and 0.2% of encounters respectively in 2006 to 30% and 3.5% of encounters in 2017. Using Medicare fee estimates, in 2017 redundant brain and neurovascular imaging for patients discharged from EDs with TIA resulted in additional charges of approximately 8,670,832 USD. Conclusion: Increasing utilization of imaging for workup of TIA across EDs in the US is also associated with substantial and increasing use of redundant imaging. We identify redundant brain and neurovascular imaging as areas that could be targeted to mitigate rising imaging expenditures.

scholarly journals Compliance With Imaging Guidelines for Workup of Transient Ischemic Attack

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2563-2567
Author(s):  
Vincent M. Timpone ◽  
Alexandria Jensen ◽  
Sharon N. Poisson ◽  
Premal S. Trivedi
Keyword(s):  
Emergency Department ◽  
Trend Analysis ◽  
Transient Ischemic Attack ◽  
Emergency Departments ◽  
Odds Ratio ◽  
International Classification Of Diseases ◽  
Multivariable Logistic Regression Analysis ◽  
Primary Analysis ◽  
Ischemic Attack ◽  
Neurovascular Imaging

Background and Purpose: Multiple societal guidelines recommend urgent brain and neurovascular imaging in patients with transient ischemic attack (TIA) to identify and treat risk factors that may lead to future stroke. The purpose of this study was to evaluate whether national imaging utilization for workup of TIA complies with society guidelines. Methods: Analysis utilized the Nationwide Emergency Department Sample. Primary analysis was performed on a 2017 cohort, and secondary trend analysis was performed on cohorts from 2006 to2017. Patients diagnosed and discharged from emergency departments with TIA were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. Demographics, health insurance, patient income, and hospital-type covariates were analyzed using a hierarchical multivariable logistic regression analysis to identify predictors of obtaining neurovascular imaging during an emergency department encounter. Results: In 2017, there were 167 999 patients evaluated and discharged from emergency departments with TIA. The percentage of patients receiving brain and neurovascular imaging was 78.5% and 43.2%, respectively. The most common imaging workup utilized was a solitary computed tomography–brain without any neurovascular imaging (30.9% of encounters). Decreased odds of obtaining neurovascular imaging was observed in Medicaid patients (odds ratio, 0.65 [95% CI, 0.58–0.74]), rural hospitals (odds ratio, 0.26 [95% CI, 0.17–0.41]), nontrauma centers (odds ratio, 0.40 [95% CI, 0.21–0.74]), and weekend encounters (odds ratio, 0.91 [95% CI, 0.85–0.96]). Trend analysis demonstrated a steady rise in brain and neurovascular imaging in 2006 from 34.9% and 6.8% of encounters, respectively, to 78.5% and 43.2% of encounters in 2017. Conclusions: Compliance with imaging guidelines is improving; however, the majority of TIA patients discharged from the emergency department do not receive recommended neurovascular imaging during their encounter. Follow-up studies are needed to determine whether delayed or incomplete vascular screening increases the risk of future stroke.

Abstract TMP78: Heterogeneous Imaging Practices Associated With Emergency Department Work-Up of Transient Ischemic Attack

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Vincent Timpone ◽  
Alexandria Jensen ◽  
Sharon Poisson ◽  
Premal Trivedi
Keyword(s):  
Emergency Department ◽  
Trend Analysis ◽  
Transient Ischemic Attack ◽  
Primary Analysis ◽  
Icd 10 ◽  
Imaging Utilization ◽  
Nationally Representative ◽  
Type Data ◽  
Ischemic Attack ◽  
Neurovascular Imaging

Introduction: Multiple societal guidelines recommend urgent imaging in patients with transient ischemic attack (TIA) to identify and treat risk factors that may lead to future stroke. Recommended studies include brain imaging, preferably with MRI, and neurovascular imaging (cranio-cervical CTA, cranio-cervical MRA or carotid ultrasound). The purpose of this study was to evaluate whether emergency department (ED) imaging utilization practices comply with recommended guidelines. Methods: Analysis utilized the Nationwide Emergency Department Sample (NEDS), a comprehensive, nationally representative sample of ED visits. Primary analysis was performed on the 2016 cohort, and a secondary trend analysis was performed on cohorts from 2006-2016. Patients diagnosed and discharged from the emergency department with transient ischemic attack were identified using ICD-9 and ICD-10 codes. Brain and neurovascular imaging obtained during the encounter were identified using CPT codes. Demographics, health insurance, patient income, and hospital type data were analyzed and a survey weighted logistic regression analysis was performed to identify predictors of obtaining neurovascular imaging. Results: In 2016 there were 183,216 patients evaluated and discharged from emergency departments with TIA. The percentage of patients receiving brain and neurovascular imaging was 75.73% and 37.99% respectively. Of the top 5 imaging work-ups utilized, the most common (34.06% of cases) was a solitary noncontrast head CT without any neurovascular imaging. Decreased odds of obtaining neurovascular imaging was observed in Medicaid patients (OR: 0.73, 95%CI: 0.66-0.80), non-trauma centers (OR: 0.42, 95%CI: 0.38-0.45), and rural hospital locations (OR: 0.30, 95%CI: 0.27-0.33). Trend analysis demonstrated a steady rise in brain and neurovascular imaging from 34.02% and 6.51% of encounters respectively in 2006 to 75.73% and 37.99% of encounters in 2016. Conclusion: The majority of TIA patients discharged from the ED do not receive recommended neurovascular imaging during their encounter. Follow-up studies are needed to determine whether delayed or incomplete vascular screening increases the risk of future stroke.

Advances In Asthma Care

2003 ◽  
Vol 1 (1) ◽  
pp. 87-90 ◽  
Author(s):  
Chris Garvey
Keyword(s):  
Healthcare Costs ◽  
Professional Organizations ◽  
Current Status ◽  
Asthma Care ◽  
Advanced Level ◽  
Clinical Criteria ◽  
Asthma Knowledge ◽  
The Past ◽  
The Us ◽  
Examination Process

Asthma rates in the US have risen during the past 25 years, as have asthma-related morbidity and healthcare costs. Professional organizations involved in asthma care have identified the need to assure that an advanced level of asthma knowledge and skill is available to patients with asthma, their families, and insurers. This need led to development of the certification for asthma educators. The Certified Asthma Educator (AE-C) must meet specific clinical criteria and pass a standardized examination designed to evaluate knowledge and skill for providing competent asthma education and coordination. The development and current status of the Certified Asthma Educator examination process and content are discussed, as are goals of the certification

BP Global Energy Outlook 2030

2013 ◽  
pp. 109-128 ◽  
Author(s):  
C. Rühl
Keyword(s):  
Emerging Economies ◽  
Energy Demand ◽  
Fossil Fuels ◽  
Net Energy ◽  
Global Energy ◽  
The Past ◽  
Market Shares ◽  
The Us ◽  
Almost All ◽  
Oil Gas

This paper presents the highlights of the third annual edition of the BP Energy Outlook, which sets out BP’s view of the most likely developments in global energy markets to 2030, based on up-to-date analysis and taking into account developments of the past year. The Outlook’s overall expectation for growth in global energy demand is to be 36% higher in 2030 than in 2011 and almost all the growth coming from emerging economies. It also reflects shifting expectations of the pattern of supply, with unconventional sources — shale gas and tight oil together with heavy oil and biofuels — playing an increasingly important role and, in particular, transforming the energy balance of the US. While the fuel mix is evolving, fossil fuels will continue to be dominant. Oil, gas and coal are expected to converge on market shares of around 26—28% each by 2030, and non-fossil fuels — nuclear, hydro and renewables — on a share of around 6—7% each. By 2030, increasing production and moderating demand will result in the US being 99% self-sufficient in net energy. Meanwhile, with continuing steep economic growth, major emerging economies such as China and India will become increasingly reliant on energy imports. These shifts will have major impacts on trade balances.

World Economy: Prospects and Barriers for Recovery

2012 ◽  
pp. 61-83 ◽  
Author(s):  
M. Ershov
Keyword(s):  
World Economy ◽  
Western World ◽  
Short Time Period ◽  
Market Segments ◽  
Junk Bonds ◽  
The Past ◽  
Time Period ◽  
The Us ◽  
Global Liquidity ◽  
Short Time

According to the latest forecasts, it will take 10 years for the world economy to get back to “decent shape”. Some more critical estimates suggest that the whole western world will have a “colossal mess” within the next 5–10 years. Regulators of some major countries significantly and over a short time‑period changed their forecasts for the worse which means that uncertainty in the outlook for the future persists. Indeed, the intensive anti‑crisis measures have reduced the severity of the past problems, however the problems themselves have not disappeared. Moreover, some of them have become more intense — the eurocrisis, excessive debts, global liquidity glut against the backdrop of its deficit in some of market segments. As was the case prior to the crisis, derivatives and high‑risk operations with “junk” bonds grow; budget problems — “fiscal cliff” in the US — and other problems worsen. All of the above forces the regulators to take unprecedented (in their scope and nature) steps. Will they be able to tackle the problems which emerge?

Holism, Chinese Medicine and Systems Ideologies: Rewriting the Past to Imagine the Future

2018 ◽  
Author(s):  
Volker Scheid
Keyword(s):  
Eighteenth Century ◽  
Chinese Medicine ◽  
Medical Humanities ◽  
Science And Technology Studies ◽  
Human Beings ◽  
The Past ◽  
Starting Point ◽  
The Us ◽  
Shared Objective ◽  
Definition Of

This chapter explores the articulations that have emerged over the last half century between various types of holism, Chinese medicine and systems biology. Given the discipline’s historical attachments to a definition of ‘medicine’ that rather narrowly refers to biomedicine as developed in Europe and the US from the eighteenth century onwards, the medical humanities are not the most obvious starting point for such an inquiry. At the same time, they do offer one advantage over neighbouring disciplines like medical history, anthropology or science and technology studies for someone like myself, a clinician as well as a historian and anthropologist: their strong commitment to the objective of facilitating better medical practice. This promise furthermore links to the wider project of critique, which, in Max Horkheimer’s definition of the term, aims at change and emancipation in order ‘to liberate human beings from the circumstances that enslave them’. If we take the critical medical humanities as explicitly affirming this shared objective and responsibility, extending the discipline’s traditional gaze is not a burden but becomes, in fact, an obligation.

The Riddle of a Common History

2009 ◽  
Vol 1 (1) ◽  
pp. 93-116 ◽  
Author(s):  
Mauricio Tenorio-Trillo
Keyword(s):  
United States ◽  
Common Ground ◽  
The United States ◽  
History Textbooks ◽  
Recent History ◽  
History Textbook ◽  
The Past ◽  
The Us ◽  
Constant Part ◽  
Intrinsic Component

By identifying two general issues in recent history textbook controversies worldwide (oblivion and inclusion), this article examines understandings of the United States in Mexico's history textbooks (especially those of 1992) as a means to test the limits of historical imagining between U. S. and Mexican historiographies. Drawing lessons from recent European and Indian historiographical debates, the article argues that many of the historical clashes between the nationalist historiographies of Mexico and the United States could be taught as series of unsolved enigmas, ironies, and contradictions in the midst of a central enigma: the persistence of two nationalist historiographies incapable of contemplating their common ground. The article maintains that lo mexicano has been a constant part of the past and present of the US, and lo gringo an intrinsic component of Mexico's history. The di erences in their historical tracks have been made into monumental ontological oppositions, which are in fact two tracks—often overlapping—of the same and shared con ictual and complex experience.

Analysis of the Nascar Hall of Fame Exhibition Event: A Generation-Based Market Segmentation Approach

2019 ◽  
Vol 23 (6) ◽  
pp. 913-926
Author(s):  
Kakyom Kim ◽  
Giri Jogaratnam
Keyword(s):  
Generation X ◽  
Market Segmentation ◽  
Generation Y ◽  
Generational Differences ◽  
The Past ◽  
The Us ◽  
Segmentation Approach ◽  
Research Findings ◽  
Hall Of Fame ◽  
Southeastern Region

Research findings on generations have been becoming useful for event organizers and destination developers over the past decades. The current study investigated generational differences in exhibition dimensions, satisfaction, and future intentions along with trip characteristics of visitors to the NASCAR Hall of Fame Exhibition event held in a medium-sized city in the southeastern region of the US. Analysis confirmed the existence of six exhibition dimensions labeled as "exhibits," "staff," "facility," "concessions," "audio tours," and "hard cards" on the event. As part of the most substantial results, there were both dissimilarities and similarities in the exhibition dimensions across four generations including "Matures," "Baby Boomers," "Generation X," and "Generation Y." Analysis also suggested significant differences in exhibition visitors' overall satisfaction, future intentions, and trip characteristics across the generations. Some useful implications are discussed for exhibition event managers and organizers.

Uncommon Grounds

2017 ◽  
Author(s):  
Jeffrey Lawrence
Keyword(s):  
American Literature ◽  
Latin American ◽  
Historical Novel ◽  
Latin American Literature ◽  
Historical Account ◽  
American Novel ◽  
Song Of Solomon ◽  
The Past ◽  
The North ◽  
The Us

This chapter turns from a historical account of the development of the US literature of experience and the Latin American literature of reading to a textual analysis of the US and Latin American historical novel. Hemispheric/inter-American scholars often cite William Faulkner’s Absalom, Absalom! (1936), Gabriel García Márquez’s One Hundred Years of Solitude (1967), and Toni Morrison’s Song of Solomon (1977) as exemplifying instances of literary borrowing across the North–South divide. As I demonstrate, however, each of the later texts also realigns its predecessor’s historical imaginary according to the dominant logics of the US and Latin American literary fields. Whereas the American works foreground experiential models of reconstructing the past and conveying knowledge across generations, García Márquez’s Latin American novel presents reading as the fundamental mode of comprehending and transmitting history.

Prohibition, Legalization, and Political Consumerism

2018 ◽  
pp. 740-769 ◽  
Author(s):  
Elizabeth A. Bennett
Keyword(s):  
Social Movements ◽  
Legal Status ◽  
Ethical Issues ◽  
Drug Control ◽  
Psychoactive Substance ◽  
Political Consumerism ◽  
Control Laws ◽  
The Past ◽  
The Us

Cannabis (marijuana) is the most commonly consumed, universally produced, and frequently trafficked psychoactive substance prohibited under international drug control laws. Yet, several countries have recently moved toward legalization. In these places, the legal status of cannabis is complex, especially because illegal markets persist. This chapter explores the ways in which a sector’s legal status interacts with political consumerism. The analysis draws on a case study of political consumerism in the US and Canadian cannabis markets over the past two decades as both countries moved toward legalization. It finds that the goals, tactics, and leadership of political consumerism activities changed as the sector’s legal status shifted. Thus prohibition, semilegalization, and new legality may present special challenges to political consumerism, such as silencing producers, confusing consumers, deterring social movements, and discouraging discourse about ethical issues. The chapter concludes that political consumerism and legal status may have deep import for one another.

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