Variation in diagnostic testing for older patients with syncope in the emergency department
Cost; Diagnostic testing; Emergency department; Near syncope; Syncope; Variation; Yield
Background Older adults presenting with syncope often undergo intensive diagnostic testing with unclear benefit. We determined the variation, frequency, yield, and costs of tests obtained to evaluate older persons with syncope.
Su Erica; Nicks Bret A; Shah Manish N; Adler David H; Bastani Aveh; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Malveau Susan E; Nishijima Daniel K; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Yagapen Annick N; Weiss Robert E; Gibson Thomas A; Baugh Christopher W; Sun Benjamin C
American Journal of Emergency Medicine
2019
2019-05
<a href="http://doi.org/10.1016/j.ajem.2018.07.043" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2018.07.043</a>
Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa.
treatment; diagnostic testing; chemoprophylaxis; institutional outbreaks; seasonal influenza
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
Uyeki Timothy M; Bernstein Henry H; Bradley John S; Englund Janet A; File Thomas M; Fry Alicia M; Gravenstein Stefan; Hayden Frederick G; Harper Scott A; Hirshon Jon Mark; Ison Michael G; Johnston B Lynn; Knight Shandra L; McGeer Allison; Riley Laura E; Wolfe Cameron R; Alexander Paul E; Pavia Andrew T
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2019
2019-03
<a href="http://doi.org/10.1093/cid/ciy866" target="_blank" rel="noreferrer noopener">10.1093/cid/ciy866</a>
Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa.
treatment; influenza; diagnostic testing; chemoprophylaxis; institutional outbreaks; seasonal
Uyeki Timothy M; Bernstein Henry H; Bradley John S; Englund Janet A; File Thomas M; Fry Alicia M; Gravenstein Stefan; Hayden Frederick G; Harper Scott A; Hirshon Jon Mark; Ison Michael G; Johnston B Lynn; Knight Shandra L; McGeer Allison; Riley Laura E; Wolfe Cameron R; Alexander Paul E; Pavia Andrew T
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2019
2019-03
<a href="http://doi.org/10.1093/cid/ciy874" target="_blank" rel="noreferrer noopener">10.1093/cid/ciy874</a>
The six-item screeinier to detect cognitive impairment in older emergency department patients
care; cognitive impairment; delirium; diagnostic testing; elderly emergency; Emergency Medicine; geriatrics; mental status; Mini-Mental State; prevalence
Background: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria. Objectives: The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients. Methods: A prospective, cross-sectional study was conducted in three urban academic medical center EDs. English-speaking ED patients :65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini-Mental State Examination (MMSE), followed by the other test 31) minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted. Results: The authors enrolled 352 subjects; III were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83). Conclusions: The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.
Wilber S T; Carpenter C R; Hustey F M
Academic Emergency Medicine
2008
2008-07
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.2008.00158.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2008.00158.x</a>