http://dgnews.docguide.com/2018-stroke-guidelines-drop-multiple-routine-tests-secondary-stroke-prevention?overlay=2&
January 30, 2018
By Alex Morrisson
LOS ANGELES -- January 30, 2018 -- Many tests given routinely in the hospital in working up a patient for secondary prevention of stroke are unnecessary and provide no clinical benefit to the patient, according to new guidelines presented here at the 2018 International Stroke Conference (ISC).
Writers of the Guidelines for the Early Management of Patients With Acute Ischemic Stroke suggested that most of these tests can be eliminated, saving the patient time and money.
“We took a hard look at the cost benefit of doing diagnostic tests to decide the best treatment for patients to prevent them from having another stroke,” said William Powers, MD, University of North Carolina, Chapel Hill, North Carolina, on January 24.
The guidelines were last updated in 2013.
“It is often assumed that just doing the tests is valuable in every patient and that is good medical practice,” Dr. Powers said. “It turns out that is actually not good medical practice.”
These tests are expensive, lead to studies that will provide no medical information about outcome, and may lead to further tests and adversely affect patient outcome.
“We have made recommendations that diagnostic testing be individualised for each patient and restricted to answering those questions that will lead to a treatment change that will help the patient do better and not do [tests] just because [of an easy] checklist,” said Dr. Powers.
According to the new guidelines, evidence does not support routine use of the following diagnostic tests in patients with acute ischaemic stroke in attempts to ensure that the patients will not have a second stroke:
• Brain magnetic resonance imaging (MRI) (no benefit). New recommendation.
• Intracranial computed tomography angiography (CTA) or magnetic resonance angiography (MRA) (no benefit). New recommendation.
• Prolonged cardiac monitoring (clinical benefit is uncertain). New recommendation.
• Echocardiography (no benefit). New recommendation.
• Blood cholesterol if a patient is not on a statin (no benefit). New recommendation.
• Obstructive sleep apnoea (no benefit). New recommendation. (Really)
• Hyperhomocysteinemia (no benefit). Unchanged from the 2013 guidelines.
• Thrombophilic states (usefulness is unknown). Unchanged from the 2013 guidelines.
• Antiphospholipid antibodies (no benefit). This recommendation is unchanged from the 2013 guidelines.
[Presentation title: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association]
LOS ANGELES -- January 30, 2018 -- Many tests given routinely in the hospital in working up a patient for secondary prevention of stroke are unnecessary and provide no clinical benefit to the patient, according to new guidelines presented here at the 2018 International Stroke Conference (ISC).
Writers of the Guidelines for the Early Management of Patients With Acute Ischemic Stroke suggested that most of these tests can be eliminated, saving the patient time and money.
“We took a hard look at the cost benefit of doing diagnostic tests to decide the best treatment for patients to prevent them from having another stroke,” said William Powers, MD, University of North Carolina, Chapel Hill, North Carolina, on January 24.
The guidelines were last updated in 2013.
“It is often assumed that just doing the tests is valuable in every patient and that is good medical practice,” Dr. Powers said. “It turns out that is actually not good medical practice.”
These tests are expensive, lead to studies that will provide no medical information about outcome, and may lead to further tests and adversely affect patient outcome.
“We have made recommendations that diagnostic testing be individualised for each patient and restricted to answering those questions that will lead to a treatment change that will help the patient do better and not do [tests] just because [of an easy] checklist,” said Dr. Powers.
According to the new guidelines, evidence does not support routine use of the following diagnostic tests in patients with acute ischaemic stroke in attempts to ensure that the patients will not have a second stroke:
• Brain magnetic resonance imaging (MRI) (no benefit). New recommendation.
• Intracranial computed tomography angiography (CTA) or magnetic resonance angiography (MRA) (no benefit). New recommendation.
• Prolonged cardiac monitoring (clinical benefit is uncertain). New recommendation.
• Echocardiography (no benefit). New recommendation.
• Blood cholesterol if a patient is not on a statin (no benefit). New recommendation.
• Obstructive sleep apnoea (no benefit). New recommendation. (Really)
• Hyperhomocysteinemia (no benefit). Unchanged from the 2013 guidelines.
• Thrombophilic states (usefulness is unknown). Unchanged from the 2013 guidelines.
• Antiphospholipid antibodies (no benefit). This recommendation is unchanged from the 2013 guidelines.
[Presentation title: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association]
Neurologists have ordered 11 MRIs/MRAs to "see if anything has changed." The results always show no change - what a waste of money.
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