en Neurology Neurology Original Article Original Article <span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:14pt"><b><i><span style="color:blue">Background</span></i></b><i><span style="color:blue">:</span></i> Echocardiography is routinely ordered in acute ischemic stroke workup. No standardized or structured criteria is used to select or exclude echocardiography in such settings. Moreover, the diagnostic yield of echocardiography in stroke is low in our medical center. This article presents newly proposed selection criteria for echocardiography in ischemic stroke workup.</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Methods:</span></i></b> A quality improvement project was implemented in a 385-bed community hospital in Maryland, USA. A computerized decision support tool consisting of new criteria for selecting echocardiography in ischemic stroke workup was created. 639 patients hospitalized with ischemic stroke were followed-up over 12 months after intervention, and 686 matched-controls with ischemic stroke were retrospectively analyzed from the 12 months prior to intervention. Cost-effectiveness and diagnostic yield of echocardiography in ischemic stroke were measured before and after intervention.<span style="font-size:10.0pt"></span></span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Results:</span></i></b> Following intervention, the diagnostic yield of echocardiography in ischemic stroke workup significantly increased by 51% (from 3.8% to 7.8%, odds ratio (OR) 2.1, <i>P= 0.01</i>). The number of echocardiography studies needed to detect and treat one patient with a cardiac source of embolism was reduced from 50 to 25 studies. The overall use of echocardiography in stroke workup significantly decreased (OR 0.4, <i>p </i>< 0.001). Patients with lacunar infarcts or atrial fibrillation had significant reduction in echocardiography (OR 0.2, <i>p </i>< 0.001 and OR 0.4,<i> p </i>< 0.001, respectively).<span style="font-size:10.0pt"></span></span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Conclusion</span></i></b><i><span style="color:blue">:</span></i> The new criteria for echocardiography selection in hospitalized patients with ischemic stroke significantly improved the cost-effectiveness and the diagnostic yield of echocardiography and reduced unnecessary echocardiography in lacunar infarcts or atrial fibrillation.<span style="font-size:10.0pt"></span></span></span></span><br> &nbsp; Acute ischemic stroke, Cardiac source of embolism, Cost-effectiveness, Echocardiography, Quality improvement 640 647 http://caspjim.com/browse.php?a_code=A-10-2090-3&slc_lang=en&sid=1 Emran El-Alali emranalali@yahoo.com 100319475328460044876 100319475328460044876 Yes Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, Maryland, USA Laith Maali lmaali@kumc.edu 100319475328460044877 100319475328460044877 No Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA