In this large observational study of 2106 patients >65 years admitted for syncope, researchers evaluated the frequency, yield, and cost of common diagnostic tests. The most commonly performed tests included EKG (99%), telemetry (95%) and cardiac enzymes (95%). All of the following tests affected diagnosis, management, or determined etiology in <5% of cases: Echo, cardiac enzymes, CT scans, carotid USG, and EEG. Postural BP affected diagnosis or management or etiology between 15-30% of cases. EEG, CT scans and cardiac enzymes were the least cost effective, and postural BP was the most cost effective (but was only performed in 38% of cases). A step-wise approach to diagnostic testing (after careful history, exam, and postural BP testing) should be utilized in older patients with syncope (abstract).
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]
By reading the headlines recently, practitioners would not know if they saved or tanked the healthcare system. One day disaster looms, the next we have moderated growth and business can continue as usual (and by business, I mean doing the correct things correctly). A new study, along with some recent data, helps shed some light […]