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Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy.

Publication ,  Journal Article
Chou, S-C; Nagurney, JM; Weiner, SG; Hong, AS; Wharam, JF
Published in: Am J Emerg Med
June 2019

OBJECTIVES: To 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. METHODS: We 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. RESULTS: From 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). CONCLUSIONS: Before 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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Published In

Am J Emerg Med

DOI

EISSN

1532-8171

Publication Date

June 2019

Volume

37

Issue

6

Start / End Page

1037 / 1043

Location

United States

Related Subject Headings

  • United States
  • Syncope
  • Quality of Health Care
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Guidelines as Topic
  • Female
  • Emergency Treatment
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chou, S.-C., Nagurney, J. M., Weiner, S. G., Hong, A. S., & Wharam, J. F. (2019). Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy. Am J Emerg Med, 37(6), 1037–1043. https://doi.org/10.1016/j.ajem.2018.08.043
Chou, Shih-Chuan, Justine M. Nagurney, Scott G. Weiner, Arthur S. Hong, and J Frank Wharam. “Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy.Am J Emerg Med 37, no. 6 (June 2019): 1037–43. https://doi.org/10.1016/j.ajem.2018.08.043.
Chou S-C, Nagurney JM, Weiner SG, Hong AS, Wharam JF. Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy. Am J Emerg Med. 2019 Jun;37(6):1037–43.
Chou, Shih-Chuan, et al. “Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy.Am J Emerg Med, vol. 37, no. 6, June 2019, pp. 1037–43. Pubmed, doi:10.1016/j.ajem.2018.08.043.
Chou S-C, Nagurney JM, Weiner SG, Hong AS, Wharam JF. Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy. Am J Emerg Med. 2019 Jun;37(6):1037–1043.
Journal cover image

Published In

Am J Emerg Med

DOI

EISSN

1532-8171

Publication Date

June 2019

Volume

37

Issue

6

Start / End Page

1037 / 1043

Location

United States

Related Subject Headings

  • United States
  • Syncope
  • Quality of Health Care
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Guidelines as Topic
  • Female
  • Emergency Treatment