A practice pathway for the initial diagnostic evaluation of isolated sixthcranial nerve palsies

Citation
Rw. Miller et al., A practice pathway for the initial diagnostic evaluation of isolated sixthcranial nerve palsies, MED DECIS M, 19(1), 1999, pp. 42-48
Citations number
81
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Health Care Sciences & Services
Journal title
MEDICAL DECISION MAKING
ISSN journal
0272-989X → ACNP
Volume
19
Issue
1
Year of publication
1999
Pages
42 - 48
Database
ISI
SICI code
0272-989X(199901/03)19:1<42:APPFTI>2.0.ZU;2-4
Abstract
Purpose: To define a practice pathway for the evaluation of sixth-nerve pal sies (SNPs) and to determine its cost-effectiveness and validity in a retro spective chart review. Methods: A Medline search of the English-language li terature from 1966 to 1995 was performed to define the available clinical e vidence and develop the practice pathway. The authors retrospectively revie wed 407 charts with the diagnosis of SNP seen at three centers. Information obtained included: etiologic diagnosis if known; development of new neurol ogic or ophthalmologic findings; and results and costs of neuroimaging stud ies, if performed. Results: Of the 407 patients, 98 underwent computed tomo graphy scans and 212 underwent magnetic resonance imaging of the head. Eigh ty cases were non-isolated, 317 were isolated SNP, and ten could not be cla ssified from chart information. Of the 317 cases of isolated SNP, 49 were c lassified as traumatic; 5, congenital; 158, vasculopathic; 63, nonvasculopa thic; and 42, progressive or unresolved. Following the recommendations of t he practice pathway, the 158 patients classified as having vasculopathic SN P would not have undergone neuroimaging studies, realizing a savings of $10 0,000 in this study population of 407 patients. Conclusion: The recommendat ions of the practice pathway are supported by review of the literature and the retrospective review of these cases. However, a prospective study with a matched control group is needed to demonstrate regional and specialty-spe cific variations in care and to strengthen the clinical certainty of the pa thway recommendations.