Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF June 8, 2012 Issue | Archived Issues

Meetings and events


Grand rounds

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Upcoming CME conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - June 2012 (PDF)


In memoriam

The following medical staff members recently passed away:

  • Irving H. Berkovitz, MD (1924-2012)
  • Stephen H. Greenberg, MD (1944-2012)
  • Sivam Ramanathan, MD (1943-2012)
  • David L. Rimoin, MD, PhD (1936-2012)

» Read more

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New guideline for patients with headache in the ED

A 54-year-old man came into the ED describing intermittent headaches for several weeks that would not go away with use of over-the-counter painkillers. He read on the Internet that his symptoms could be due to a brain tumor or hemorrhage and became increasingly concerned. His primary care provider was not available to see him for another three weeks so he decided to go to the hospital to get it checked out. He asked for an MRI or a CT scan.

This scenario occurs not infrequently in emergency departments throughout the country, with Cedars-Sinai being no exception. Overuse of diagnostic testing and procedures increase costs to patients, taxpayers and employers, drives up insurance premiums, and thus represents a poor quality of care. Most headaches can be accurately evaluated by clinical history and physical exam. Diagnostic neuroimaging in these cases is neither needed nor desirable, as it is more likely to yield false positive findings while exposing many patients to unnecessary and harmful radiation.

To help ensure that patients receive the most appropriate care at the right time and cost, a Cedars-Sinai Medicine task force has created a new guideline for the appropriate use of neuroimaging for people presenting with a traumatic headache in the ED. Patients who do not meet the indications listed in the following guideline   CSM Neuroimaging Guidelines (PDF) may be treated without emergent diagnostic neuroimaging.

The new guideline provides:

  • A list of supportable indications for neuroimaging in the ED;
  • Identification of preferred modalities for each indication;
  • A list of indications when CT or MRI may be appropriate, but not emergent

"Our goal is to reduce and eliminate the utilization of diagnostic neuroimaging in patients who don’t need them, while ensuring that patients with high-risk features receive rapid diagnosis with the best test supported by current evidence in the literature. We want our practice to be the best in both quality and cost-effectiveness,” said Sam Torbati, MD, vice chair of the Emergency Department." A similar test of change was implemented six months ago in the ED for non-Code Brain ischemic stroke patients and has been very successful in reducing redundant brain imaging, allowing many patients to be discharged home instead of being admitted. Both protocols are aimed at doing the right test for the right patient in the right setting, or no testing at all if not clinically indicated.”

This guideline was developed by the Cedars-Sinai Medicine task force after conducting a comprehensive review of published indications developed by expert bodies such as the American College of Radiology and the American College of Emergency Physicians. These indications were aggregated into a single guideline that has been approved by the Department PICs of Emergency Medicine, Neurology, Neurosurgery, Internal Medicine and Radiology, according to Glenn D. Braunstein, MD, vice president of Clinical Innovation.