National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Events (1)
- Blood Clots (1)
- Brain Injury (3)
- Cancer (2)
- Cancer: Breast Cancer (2)
- Cancer: Colorectal Cancer (1)
- Cardiovascular Conditions (2)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (6)
- Communication (1)
- (-) Decision Making (27)
- Dementia (1)
- Diagnostic Safety and Quality (9)
- Elderly (2)
- Emergency Department (6)
- Emergency Medical Services (EMS) (3)
- Evidence-Based Practice (4)
- Guidelines (7)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (2)
- Health Services Research (HSR) (2)
- (-) Imaging (27)
- Kidney Disease and Health (3)
- Medical Errors (1)
- Neurological Disorders (2)
- Orthopedics (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (2)
- Policy (1)
- Practice Patterns (4)
- Prevention (2)
- Primary Care (1)
- Provider (2)
- Provider: Clinician (1)
- Provider: Health Personnel (1)
- Provider: Physician (2)
- Quality Improvement (2)
- Quality of Care (1)
- Respiratory Conditions (2)
- Screening (2)
- Stroke (1)
- Surgery (1)
- Women (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 27 Research Studies DisplayedRoss RL, Rubio K, Rodriguez HP
Mammography and decision aid use for breast cancer screening in older women.
This study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2016-17 Medicare fee-for-service beneficiary data from eligible beneficiaries aged 65-74 years. Findings showed that health information technology-enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision.
AHRQ-funded; HS022241; HS024075.
Citation: Ross RL, Rubio K, Rodriguez HP .
Mammography and decision aid use for breast cancer screening in older women.
Am J Prev Med 2022 Oct;63(4):630-35. doi: 10.1016/j.amepre.2022.04.014..
Keywords: Imaging, Screening, Decision Making, Cancer: Breast Cancer, Women, Prevention, Cancer, Elderly
Marin JR, Rodean J, Mannix RC
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
The objective of this study was to examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) were associated with lower head computed tomography (CT) use. The investigators concluded that clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Mannix RC .
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
J Pediatr 2021 Aug;235:178-83.e1. doi: 10.1016/j.jpeds.2021.04.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Brain Injury, Guidelines, Evidence-Based Practice, Imaging
Long S, Thomas GW, Karam MD
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
This study introduces and evaluates a novel Image-based Decision Error Analysis (IDEA) score that captures performance during fluoroscopically assisted wire navigation. Findings showed that the fluoroscopic images obtained in the course of placing a guide wire contained a rich amount of information related to surgical skill. The IDEA scoring provided a basis for evaluating the competence of a resident. The score can be used to assess skill at key timepoints throughout residency, such as when rotating onto/off of a new surgical service and before performing certain procedures in the operating room, or as a tool for debriefing/providing feedback after a procedure is completed.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Karam MD .
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
Clin Orthop Relat Res 2021 Jun;479(6):1386-94. doi: 10.1097/corr.0000000000001623..
Keywords: Orthopedics, Surgery, Decision Making, Medical Errors, Adverse Events, Imaging
Schoenfeld EM, Poronsky KE, Westafer LM
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Both ultrasound and CT scan can be used for diagnosis of ureterolithiasis (or renal colic, the pain from an obstructing kidney stone), but the majority of patients receive a CT scan. Diagnostic pathways utilizing ultrasound have been shown to decrease radiation exposure to patients but are potentially less accurate. The investigators developed a decision aid to facilitate SDM in this scenario. The objective of this study was to determine the effects of this decision aid, as compared to usual care, on patient knowledge, radiation exposure, engagement, safety, and healthcare utilization.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Poronsky KE, Westafer LM .
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Trials 2021 Mar 10;22(1):201. doi: 10.1186/s13063-021-05140-9..
Keywords: Emergency Department, Decision Making, Kidney Disease and Health, Imaging, Diagnostic Safety and Quality
Chen DW, Reyes-Gastelum D, Radhakrishnan A
Physician-reported misuse of thyroid ultrasonography.
The authors explored physician-reported use of thyroid ultrasonography. They found that a substantial number of physicians endorsed the use of ultrasonography for reasons not supported by clinical guidelines and in conflict with the Choosing Wisely recommendations. They concluded that their study highlights the need for focused physician education on clinically supported and unsupported indications for use of thyroid ultrasonography, with potential roles for future clinical practice guidelines, patient decision-making aids, and clinical decision-making support tools.
AHRQ-funded; HS024512.
Citation: Chen DW, Reyes-Gastelum D, Radhakrishnan A .
Physician-reported misuse of thyroid ultrasonography.
JAMA Surg 2020 Oct;155(10):984-86. doi: 10.1001/jamasurg.2020.2507..
Keywords: Imaging, Decision Making, Guidelines, Evidence-Based Practice
Schoenfeld EM, Houghton C, Patel PM
Shared decision making in patients with suspected uncomplicated ureterolithiasis: a decision aid development study.
The objective of this study was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis. Using stakeholder engagement and qualitative inquiry, the investigators developed their evidence-based DA. They indicated that future research will test the efficacy of the DA in facilitating SDM.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Houghton C, Patel PM .
Shared decision making in patients with suspected uncomplicated ureterolithiasis: a decision aid development study.
Acad Emerg Med 2020 Jul;27(7):554-65. doi: 10.1111/acem.13917..
Keywords: Decision Making, Emergency Department, Imaging, Diagnostic Safety and Quality
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Richardson S, Cohen S, Khan S
Higher imaging yield when clinical decision support is used.
Increased utilization of CT pulmonary angiography (CTPA) for the evaluation of pulmonary embolism has been associated with decreasing diagnostic yields and rising concerns about the harms of unnecessary testing. The objective of this study was to determine whether clinical decision support (CDS) use would be associated with increased imaging yields after controlling for selection bias.
AHRQ-funded; HS022061.
Citation: Richardson S, Cohen S, Khan S .
Higher imaging yield when clinical decision support is used.
J Am Coll Radiol 2020 Apr;17(4):496-503. doi: 10.1016/j.jacr.2019.11.021.
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Keywords: Clinical Decision Support (CDS), Imaging, Diagnostic Safety and Quality, Decision Making, Blood Clots
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Cochon LR, Kapoor N, Carrodeguas E
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
The purpose of this study was to determine the incidence and to identify factors associated with follow-up recommendations in radiology reports from multiple modalities, patient care settings, and imaging divisions. A trained algorithm classified 318,366 report; the findings indicate that substantial interradiologist variation exists in the probability of recommending a follow-up examination in a radiology report.
AHRQ-funded; HS024722.
Citation: Cochon LR, Kapoor N, Carrodeguas E .
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
Radiology 2019 Jun;291(3):700-07. doi: 10.1148/radiol.2019182826..
Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Patient Safety, Quality of Care, Quality Improvement
Pappadis MR, Volk RJ, Krishnan S
Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis.
The authors explored older women's perceptions about the concept of overdetection of breast cancer and its influence on future screening intentions. Semistructured interviews were conducted with 59 English-speaking women aged 70 years or older with no prior history of breast cancer. The authors found that many older women did not understand the concept of overdetection, in addition to being suspicious of or resistant to the concept. Providing older women with descriptions of overdetection may not be sufficient to influence screening intentions.
AHRQ-funded; HS022134.
Citation: Pappadis MR, Volk RJ, Krishnan S .
Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis.
BMJ Open 2018 Jun 14;8(6):e022138. doi: 10.1136/bmjopen-2018-022138..
Keywords: Cancer: Breast Cancer, Cancer, Elderly, Screening, Decision Making, Women, Prevention, Imaging
Sharp AL, Huang BZ, Tang T
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
The researchers evaluated the association of implementation of the Canadian CT Head Rule on head computed tomography (CT) imaging in community emergency departments (EDs). They found that a multicomponent implementation of the Canadian CT Head Rule was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for adult trauma encounters in community EDs.
AHRQ-funded; HS021271.
Citation: Sharp AL, Huang BZ, Tang T .
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
Ann Emerg Med 2018 Jan;71(1):54-63.e2. doi: 10.1016/j.annemergmed.2017.06.022.
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Keywords: Brain Injury, Clinical Decision Support (CDS), Decision Making, Emergency Department, Guidelines, Healthcare Utilization, Imaging
Ladapo JA, Blecker S, O'Donnell M
Appropriate use of cardiac stress testing with imaging: a systematic review and meta-analysis.
The authors systematically reviewed studies of appropriate use criteria (AUC), evaluated trends over time, and characterized leading indications for inappropriate testing. They found that rates of appropriate use tend to be lower for stress echocardiography compared to myocardial perfusion imaging, and updated AUC reduced unclassified stress echocardiograms. They concluded that there is no conclusive evidence that AUC improved appropriate use over time.
AHRQ-funded; HS023683.
Citation: Ladapo JA, Blecker S, O'Donnell M .
Appropriate use of cardiac stress testing with imaging: a systematic review and meta-analysis.
PLoS One 2016 Aug 18;11(8):e0161153. doi: 10.1371/journal.pone.0161153.
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Keywords: Cardiovascular Conditions, Decision Making, Imaging, Guidelines
Melnick ER, O'Brien EG, Kovalerchik O
The association between physician empathy and variation in imaging use.
This paper's objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. The authors found that, on the four psychometric scales used, performance was not predictive of risk-adjusted CT utilization in the emergency department. They concluded that the underlying physician-based factors that mediate interphysician variation remain to be clearly identified.
AHRQ-funded; HS021271.
Citation: Melnick ER, O'Brien EG, Kovalerchik O .
The association between physician empathy and variation in imaging use.
Acad Emerg Med 2016 Aug;23(8):895-904. doi: 10.1111/acem.13017.
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Keywords: Decision Making, Emergency Medical Services (EMS), Healthcare Utilization, Imaging, Practice Patterns
John-Baptiste A, Schapira MM, Cravens C
AHRQ Author: John-Baptiste A, Cravens C, Siegel J, Lawrence W
The role of decision models in health care policy: a case study.
In 2009, the Centers for Medicare and Medicaid Services (CMS) underwent a National Coverage Determination on computed tomography colonography (CTC) to screen for colorectal cancer. The Cancer Intervention & Surveillance Network developed decision models to inform this decision. The purpose of this study was to investigate the role of models in this decision. It concluded that decision makers involved in the CTC decision believed in the adequacy of models to inform coverage decisions.
AHRQ-authored.
Citation: John-Baptiste A, Schapira MM, Cravens C .
The role of decision models in health care policy: a case study.
Med Decis Making 2016 Jul;36(5):666-79. doi: 10.1177/0272989x16646732.
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Keywords: Cancer: Colorectal Cancer, Decision Making, Imaging, Policy
Wang RC, Bent S, Weber E
The impact of clinical decision rules on computed tomography use and yield for pulmonary embolism: a systematic review and meta-analysis.
The researchers performed a systematic review of impact analyses on clinical decision rules for pulmonary embolism. They found that among participants with suspected pulmonary embolism, implementation of the Wells criteria was associated with a modest increase in CT angiography yield. They concluded that there is a lack of cluster-randomized trials to confirm the efficacy of clinical decision rules for the diagnosis of pulmonary embolism.
AHRQ-funded; HS021281.
Citation: Wang RC, Bent S, Weber E .
The impact of clinical decision rules on computed tomography use and yield for pulmonary embolism: a systematic review and meta-analysis.
Ann Emerg Med 2016 Jun;67(6):693-701.e3. doi: 10.1016/j.annemergmed.2015.11.005.
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Keywords: Clinical Decision Support (CDS), Decision Making, Imaging, Respiratory Conditions
Wang RC, Rodriguez RM, Moghadassi M
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. The researchers evaluated the STONE score compared with physician gestalt. They concluded that in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone.
AHRQ-funded; HS021281; HS019312.
Citation: Wang RC, Rodriguez RM, Moghadassi M .
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
Ann Emerg Med 2016 Apr;67(4):423-32.e2. doi: 10.1016/j.annemergmed.2015.08.019.
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Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Kidney Disease and Health, Practice Patterns
Daniels B, Gross CP, Molinaro A
STONE PLUS: evaluation of emergency department patients with suspected renal colic, using a clinical prediction tool combined with point-of-care limited ultrasonography.
This study sought to determine whether renal point-of-care limited ultrasonography (PLUS) used in conjunction with the Sex, Timing, Origin, Nausea, Erythrocytes (STONE) clinical prediction score can aid identification of emergency department (ED) patients with uncomplicated ureteral stone or need for urologic intervention. It concluded that hydronephrosis on renal PLUS modestly improved risk stratification in low- and moderate-risk STONE score patients.
AHRQ-funded; HS018322.
Citation: Daniels B, Gross CP, Molinaro A .
STONE PLUS: evaluation of emergency department patients with suspected renal colic, using a clinical prediction tool combined with point-of-care limited ultrasonography.
Ann Emerg Med 2016 Apr;67(4):439-48. doi: 10.1016/j.annemergmed.2015.10.020.
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Keywords: Decision Making, Emergency Department, Imaging, Kidney Disease and Health
Ladapo JA, Blecker S, Douglas PS
Appropriateness of cardiac stress test use among primary care physicians and cardiologists in the United States.
In this study, the researchers used nationally-representative data to examine differences in appropriate use of cardiac stress testing between cardiologists and primary care physicians (PCPs) in the US. Using permissive criteria to determine appropriateness, they found that primary care physicians are more likely to order or perform a rarely appropriate cardiac stress test than cardiologists.
AHRQ-funded; HS023683.
Citation: Ladapo JA, Blecker S, Douglas PS .
Appropriateness of cardiac stress test use among primary care physicians and cardiologists in the United States.
Int J Cardiol 2016 Jan 15;203:584-6. doi: 10.1016/j.ijcard.2015.10.238.
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Keywords: Cardiovascular Conditions, Diagnostic Safety and Quality, Imaging, Primary Care, Decision Making
Finnerty NM, Rodriguez RM, Carpenter CR
Clinical decision rules for diagnostic imaging in the emergency department: a research agenda.
The objective of this working group and article was to generate a consensus-based research agenda for the development and implementation of clinical decision rules (CDRs) for diagnostic imaging in the emergency department. A research agenda was developed, prioritizing a number of questions, including: what are the optimal methods to justify the derivation and validation of diagnostic imaging CDRs?
AHRQ-funded; HS023498.
Citation: Finnerty NM, Rodriguez RM, Carpenter CR .
Clinical decision rules for diagnostic imaging in the emergency department: a research agenda.
Acad Emerg Med 2015 Dec;22(12):1406-16. doi: 10.1111/acem.12828.
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Keywords: Decision Making, Emergency Department, Health Services Research (HSR), Imaging
Blackmore CC, Castro A
Improving the quality of imaging in the emergency department.
The six-tier efficacy hierarchy of Fryback and Thornbury enables understanding of the value of imaging on multiple levels, ranging from technical efficacy to medical decision-making and higher-level patient and societal outcomes. In this article, the authors elucidate the Fryback and Thornbury framework to define the value of imaging in the ED and to relate emergency imaging to the IOM quality domains.
AHRQ-funded; HS023498.
Citation: Blackmore CC, Castro A .
Improving the quality of imaging in the emergency department.
Acad Emerg Med 2015 Dec;22(12):1385-92. doi: 10.1111/acem.12816.
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Keywords: Decision Making, Emergency Department, Imaging, Quality Improvement
Melnick ER, Shafer K, Rodulfo N
Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study.
The objective was to identify nonclinical, human factors that promote or inhibit the appropriate use of computed tomography (CT) in patients presenting to the emergency department (ED) with minor head injury. Five core domains emerged from the analysis: establishing trust, anxiety (patient and provider), constraints related to ED practice, the influence of others, and patient expectations.
AHRQ-funded; HS021271.
Citation: Melnick ER, Shafer K, Rodulfo N .
Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study.
Acad Emerg Med 2015 Dec;22(12):1474-83. doi: 10.1111/acem.12824.
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Keywords: Emergency Medical Services (EMS), Imaging, Brain Injury, Decision Making, Health Services Research (HSR)
Callaghan BC, Kerber KA, Pace RJ
Headache neuroimaging: routine testing when guidelines recommend against them.
The aim of this article was to determine the patient-level factors associated with headache neuroimaging in outpatient practice. It concluded that neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags).
AHRQ-funded; HS017690.
Citation: Callaghan BC, Kerber KA, Pace RJ .
Headache neuroimaging: routine testing when guidelines recommend against them.
Cephalalgia 2015 Nov;35(13):1144-52. doi: 10.1177/0333102415572918.
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Keywords: Neurological Disorders, Imaging, Decision Making, Guidelines, Diagnostic Safety and Quality
Melnick ER, Keegan J, Taylor RA
Redefining overuse to include costs: a decision analysis for computed tomography in minor head injury.
This study was conducted to (1) determine the testing threshold for head computed tomography (CT) in minor head injury in the emergency department using decision analysis with and without costs included in the analysis. If only effectiveness is considered, current clinical decision rules might not provide a sufficient degree of certainty to ensure identification of all patients for whom the benefits of CT outweigh its risks.
AHRQ-funded; HS021271.
Citation: Melnick ER, Keegan J, Taylor RA .
Redefining overuse to include costs: a decision analysis for computed tomography in minor head injury.
Jt Comm J Qual Patient Saf 2015 Jul;41(7):313-22..
Keywords: Clinical Decision Support (CDS), Decision Making, Imaging, Emergency Medical Services (EMS)
George AJ, Boehme AK, Dunn CR
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
The authors questioned the utility of routine 24-h computed tomography imaging and looked at the National Institutes of Health Stroke Scale as a possible clinical screen for selecting candidates for 24-h imaging. They found that routine 24-h computed tomography scan in patients without 24-h National Institutes of Health Stroke Scale worsening was less likely to yield information that results in a deviation from standard acute stroke care, and that no patient without worsening had parenchymal hematoma on 24-h computed tomography. They concluded that application of this Stroke Scale to distinguish patients who should have 24-h follow-up imaging from those who will not benefit is a potential avenue for improving utilization of resources and warrants further study.
AHRQ-funded; HS013852.
Citation: George AJ, Boehme AK, Dunn CR .
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
Int J Stroke 2015 Jan;10(1):37-41. doi: 10.1111/ijs.12293.
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Keywords: Decision Making, Imaging, Stroke