Patterns of utilization of extracranial neurovascular ultrasound in patients with syncope in the context of the American Academy of Neurology (AAN) Choosing Wisely initiative. (P2.187)

Objective: To determine the clinical impact of the AAN Choosing Wisely recommendations on the use of ENVU in patients with syncope, at Loyola University Medical Center. Background: Cost - effectiveness in practice depend on careful patient selection. Studies have shown the low yield of extracranial neurovascular ultrasound (ENVU) for syncope. The Choosing Wisely initiative of the AAN released on February 21 st , 2013, described a list of unnecessary tests regularly ordered, and recommended against ENVU in the evaluation of syncope not associated with other neurologic symptoms. However, the impact of the AAN recommendations in the “real world” has not been fully evaluated. Design/Methods: We retrospectively analyzed medical records of patients with diagnosis of syncope (ICD-9 780.2) at our institution between January 1 st , 2011 and December 31 st , 2015. Multiple variables were assessed, and categorized in two distinct groups, before and after the release of the AAN Choosing Wisely recommendations. Results: 1975 patients with syncope were seen at our institution; 920 patients presented before the official release of the AAN recommendations. ENVU was performed in 91 of these patients (10%). After the AAN recommendations were released, a total of 1055 patients presented with syncope. ENVU was done in 173 of these patients (16%). ENVU demonstrated Conclusions: The clinical value of ENVU in syncope evaluation is not well established. Our study demonstrated a local increase utilization of ENVU despite AAN recommendations. We suspect our observations are not unique to our institution, and encourage colleagues to review the Choosing Wisely campaign in order to implement cost – effective practices in the evaluation of syncope. Study Supported by: n/a Disclosure: Dr. Ortiz-Garcia has nothing to disclose. Dr. Bruzzone Giraldez has nothing to disclose. Dr. Andino has nothing to disclose. Dr. Sweis has nothing to disclose. Dr. Gomez has received personal compensation for activities with Biokine Inc., as an employee. Dr. Biller has received personal compensation in an editorial capacity forThe Journal of Stroke and Cerebrovascular Diseases, Frontiers in Neurology, and Up-To-Date.