Document Detail

A practice pathway for the initial diagnostic evaluation of isolated sixth cranial nerve palsies.
MedLine Citation:
PMID:  9917019     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To define a practice pathway for the evaluation of sixth-nerve palsies (SNPs) and to determine its cost-effectiveness and validity in a retrospective chart review. METHODS: A Medline search of the English-language literature from 1966 to 1995 was performed to define the available clinical evidence and develop the practice pathway. The authors retrospectively reviewed 407 charts with the diagnosis of SNP seen at three centers. Information obtained included: etiologic diagnosis if known; development of new neurologic or ophthalmologic findings; and results and costs of neuroimaging studies, if performed. RESULTS: Of the 407 patients, 98 underwent computed tomography scans and 212 underwent magnetic resonance imaging of the head. Eighty cases were non-isolated, 317 were isolated SNP, and ten could not be classified from chart information. Of the 317 cases of isolated SNP, 49 were classified as traumatic; 5, congenital; 158, vasculopathic; 63, nonvasculopathic; and 42, progressive or unresolved. Following the recommendations of the practice pathway, the 158 patients classified as having vasculopathic SNP would not have undergone neuroimaging studies, realizing a savings of $100,000 in this study population of 407 patients. CONCLUSION: The recommendations 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-specific variations in care and to strengthen the clinical certainty of the pathway recommendations.
R W Miller; A G Lee; J S Schiffman; T C Prager; R Garza; P F Jenkins; P Sforza; A Verm; D Kaufman; W Robinson; E Eggenberger; R A Tang
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical decision making : an international journal of the Society for Medical Decision Making     Volume:  19     ISSN:  0272-989X     ISO Abbreviation:  Med Decis Making     Publication Date:    1999 Jan-Mar
Date Detail:
Created Date:  1999-04-13     Completed Date:  1999-04-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8109073     Medline TA:  Med Decis Making     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  42-8     Citation Subset:  IM    
Department of Ophthalmology at the University of Texas Medical School at Houston, USA.
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MeSH Terms
Abducens Nerve*
Cranial Nerve Diseases / diagnosis*,  etiology
Decision Trees*
Magnetic Resonance Imaging
Paralysis / diagnosis*,  etiology
Retrospective Studies
Tomography, X-Ray Computed

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