{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T21:45:33Z","timestamp":1747172733330,"version":"3.40.5"},"reference-count":16,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>ABSTRACT:<\/jats:title><jats:sec id=\"S0317167123000112_as1\"><jats:title>Background:<\/jats:title><jats:p>Cardiac sources of emboli can be identified by transthoracic echocardiogram (TTE). The Canadian Best Practice Guidelines recommend routine use of TTE in the initial workup of ischemic stroke when an embolic source is suspected. However, TTEs are commonly ordered for all patients despite insufficient evidence to justify cost-effectiveness. We aim to evaluate the TTE ordering pattern in the initial workup of ischemic stroke at a regional Stroke Center in Central South Ontario and determine the proportion of studies which led to a change in management and affected length of stay (LOS).<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123000112_as2\"><jats:title>Methods:<\/jats:title><jats:p>Hospital records of 520 patients with a discharge diagnosis of TIA or ischemic stroke between October 2016 and June 2017 were reviewed to gather information<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123000112_as3\"><jats:title>Results:<\/jats:title><jats:p>477 patients admitted for TIA or ischemic stroke met inclusion criteria. 67.9% received TTE, out of which 6.0% had findings of cardiac sources of emboli including left ventricular thrombus, atrial septal aneurysm, PFO, atrial myxoma, and valvular vegetation. 2.5% of all TTE findings led to change in medical management. The median LOS of patients who underwent TTE was 2 days longer (<jats:italic>p<\/jats:italic> &lt; 0.00001).<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123000112_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>TTE in the initial workup of TIA or ischemic stroke remains common practice. The yield of TTEs is low, and the proportion of studies that lead to changes in medical management is minimal. TTE completion was associated with increased LOS and may result in increased healthcare spending; however, additional factors prolonging the LOS could not be excluded.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cjn.2023.11","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T08:56:13Z","timestamp":1674550573000},"page":"73-77","source":"Crossref","is-referenced-by-count":0,"title":["The Utility of Echocardiogram in the Workup of Ischemic Stroke Patients"],"prefix":"10.1017","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5588-6473","authenticated-orcid":false,"given":"Linda A.","family":"Villani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan","family":"Guay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"DeDominicis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aadil","family":"Bharwani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikola","family":"Po\u010du\u010da","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanjana","family":"Perera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"key":"S0317167123000112_ref16","doi-asserted-by":"publisher","DOI":"10.1185\/03007990903102743"},{"key":"S0317167123000112_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.09.035"},{"key":"S0317167123000112_ref1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06669-w"},{"key":"S0317167123000112_ref11","unstructured":"11. Canadian Agency for Drugs and Technologies in Health. Transthoracic echocardiography in adult patients with ischemic stroke: a review of the diagnostic yield and cost effectiveness, 2014. Available at: https:\/\/www.cadth.ca\/media\/pdf\/htis\/nov-2014\/RC0598-TransthoracicEcho-Final.pdf"},{"key":"S0317167123000112_ref2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.551226"},{"key":"S0317167123000112_ref13","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190111"},{"volume-title":"Effectiveness and cost-effectiveness of echocardiography and carotid Imaging in the management of stroke","year":"2002","author":"Meenan","key":"S0317167123000112_ref5"},{"key":"S0317167123000112_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(00)80068-5"},{"key":"S0317167123000112_ref15","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200995"},{"key":"S0317167123000112_ref7","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"S0317167123000112_ref6","unstructured":"6. Inpatient Prevention and Management of Complications following Stroke. Canadian Stroke Best Practices. Accessed June 3, 2022. https:\/\/www.strokebestpractices.ca\/en\/recommendations\/acute-stroke-management\/inpatient-prevention-and-management-of-complications-following-stroke\/"},{"key":"S0317167123000112_ref8","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960220605"},{"key":"S0317167123000112_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.01.004"},{"key":"S0317167123000112_ref9","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003063"},{"key":"S0317167123000112_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)70027-X"},{"key":"S0317167123000112_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30002-9"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167123000112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T11:02:43Z","timestamp":1710414163000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167123000112\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,24]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["S0317167123000112"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2023.11","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"type":"print","value":"0317-1671"},{"type":"electronic","value":"2057-0155"}],"subject":[],"published":{"date-parts":[[2023,1,24]]}}}