ArticleThe American journal of emergency medicine2019
Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy.
Article in The American journal of emergency medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 15 citations in OpenAlex.
- Time trend analysis of Injury Severity score of adult trauma patients with emergent CT examination.Emergency radiology · 2024Article
- Interhospital variability in hospital admissions for patients with low-risk syncope presenting to the emergency department.Heart rhythm O2 · 2024Article
- Syncope in the Emergency Department: A Practical Approach.Journal of clinical medicine · 2024Review
- Everyone eventually goes to ground: Distinguishing true syncope from mimics for emergency department studies on syncope in older persons.Journal of the American College of Emergency Physicians open · 2022Article
- Article
- Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework.Medicina (Kaunas, Lithuania) · 2021Review
- Regional variation in outcomes and healthcare resources utilization in, emergency department visits for syncope.The American journal of emergency medicine · 2021Article
- Value-based syncope evaluation and management: Perspectives of health care professionals on readiness, barriers and enablers.The American journal of emergency medicine · 2020Article
- Low-value care practice in headache: a Spanish mixed methods research study.The journal of headache and pain · 2020Article
- Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey.The western journal of emergency medicine · 2020Article
- Article
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered "low-value", and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.
methodsWe analyzed 2002-2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.
resultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: -3.1%; 95%CI -4.7, -1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: -2.2%; 95%CI -3.0, -1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: -0.6%; 95%CI -2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI -1.9, 2.0]; -0.9% [95%CI -3.1, 1.3]; and -1.2% [95%CI -5.3, 2.9], respectively).
conclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.
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