{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T11:09:59Z","timestamp":1767611399625,"version":"3.41.2"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,6,15]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Accurate diagnosis of patients with transient or minor neurological events can be challenging. Recent studies suggest that advanced neuroimaging can improve diagnostic accuracy in low\u2010risk patients with transient or minor neurological symptoms, but a cost\u2010effective emergency department diagnostic evaluation strategy remains uncertain.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We constructed a decision\u2010analytic model to evaluate 2 diagnostic evaluation strategies for patients with low\u2010risk transient or minor neurological symptoms: (1) obtain advanced neuroimaging (magnetic resonance imaging brain and magnetic resonance angiography head and neck) on every patient or (2) current emergency department standard\u2010of\u2010care clinical evaluation with basic neuroimaging. Main probability variables were: proportion of patients with true ischemic events, strategy specificity and sensitivity, and recurrent stroke rate. Direct healthcare costs were included. We calculated incremental cost\u2010effectiveness ratios, conducted sensitivity analyses, and evaluated various diagnostic test parameters primarily using a 1\u2010year time horizon. Cost\u2010effectiveness standards would be met if the incremental cost\u2010effectiveness ratio was less than willingness to pay. We defined willingness to pay as $100\u00a0000 US dollars per quality\u2010adjusted life year. Our primary and sensitivity analyses found that the advanced neuroimaging strategy was more cost\u2010effective than emergency department standard of care. The incremental effectiveness of the advanced neuroimaging strategy was slightly less than the standard\u2010of\u2010care strategy, but the standard\u2010of\u2010care strategy was more costly. Potentially superior diagnostic approaches to the modeled advanced neuroimaging strategy would have to be &gt;92% specific, &gt;70% sensitive, and cost less than or equal to standard\u2010of\u2010care strategy\u2019s cost.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Obtaining advanced neuroimaging on emergency department patient with low\u2010risk transient or minor neurological symptoms was the more cost\u2010effective strategy in our model.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019001","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T09:20:02Z","timestamp":1622452802000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Cost\u2010Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0184-6035","authenticated-orcid":false,"given":"Ava L.","family":"Liberman","sequence":"first","affiliation":[{"name":"Department of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Center for Health and the Social Sciences University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara K.","family":"Rostanski","sequence":"additional","affiliation":[{"name":"Department of Neurology New York University Grossman School of Medicine New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie T.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1455-9345","authenticated-orcid":false,"given":"Charles C.","family":"Esenwa","sequence":"additional","affiliation":[{"name":"Department of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Haranhalli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Radiology Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medicine Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0754-4345","authenticated-orcid":false,"given":"Daniel L.","family":"Labovitz","sequence":"additional","affiliation":[{"name":"Department of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard B.","family":"Lipton","sequence":"additional","affiliation":[{"name":"Department of Neurology Albert Einstein College of MedicineMontefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0724-1694","authenticated-orcid":false,"given":"Shyam","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago School of Medicine Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12614"},{"key":"e_1_3_1_3_2","volume-title":"National Academies of Sciences E, and Medicine. 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