2024 American Academy of Neurology Abstract Website

Objective:

Rising healthcare costs and limited access encourage physicians to judiciously order tests for changing patient management. We aim to predict changes in management for Evoked Potentials (EPs), including Somatosensory Evoked Potentials (SSEPs), Brainstem Auditory Evoked Potentials (BAEPs), and Visual Evoked Potentials (VEPs) by cross-sectional analysis of indication, acuity of symptoms, location of testing, and testing results.

Background:

EPs localize lesions, prognosticate, and provide intraoperative monitoring. Professional opinion suggests inpatient EPs more commonly change management than outpatient studies due to prognostication after anoxic brain injury. EPs for acute symptoms are hypothesized to change management more often than for chronic symptoms. EPs with demyelinating disease and functional neurologic disorder indications are hypothesized to change management often.

Design/Methods:

Charts of adult patients (n=110) were examined for EP type, location, indication, and symptom onset. “Change in management” occurred if medications were started/stopped, workup was broadened/discontinued, or redirection of care or early discharge occurred. 28 VEPs, 65 SSEPs, and 29 BAEPs were analyzed with more than one EP modality performed in some cases. Categorical data were analyzed using Chi-Squared (χ2) statistics.

Results:

EPs ordered for acute symptoms (<1 month) were more likely to change management than for chronic symptoms (OR=6.07,χ²=6.80,p=0.009). Inpatient EPs were more likely to change management than outpatient studies (OR=15,χ²=13.5,p=0.00023). Normal VEPs and SSEPs were less likely to change management than abnormal studies (OR=0.1,χ²=3.86,p=0.049;OR=0.28,χ²=3.98,p=0.04). VEPs and SSEPs performed for demyelinating diseases were not more likely to change management than for other indications (OR=3.17,χ²=1.25,p=0.26;OR=0.536,χ²=0.321,p=0.571). VEPs and SSEPs performed for functional neurologic disorders were not more likely to change management than for other indications (OR=0,χ²=1.01,p=0.313;OR=0.65,χ²=0.145,p=0.703). BAEPs did not change management in any cases.

Conclusions:

EPs are more likely to change management for acute symptoms (<1 month) and in the inpatient setting. Abnormal SSEPs and VEPs changed management often, regardless of testing indication. Clinicians maximize management changes with these EPs.