Abstracts

More than 32,000 patients have been implanted with the vagus nerve stimulator for treatment of epilepsy or depression.
Early recognition of the presence of a VNS implant in the emergency room setting is extremely important.
We evaluated how frequently physicians can recognize a vagus nerve stimulator when presented with a routine chest X-ray and a limited clinical history., A medical student without any obvious link to the neurology department distributed the survey and presented the chest X-ray at internal medicine grand rounds and morning report.
The survey showed a chest X-ray with a VNS inplant and the following clinical data:
A patient presents to the ER following a brief loss of consciousness, no further history is available at this time.
Two questions were asked.
1. Write a brief description of the chest x-ray shown.
2. What is the underlying diagnosis?, Total participants (N=55)
For Question 1:
1 (2%) surveyed recognized the presence of a vagus nerve stimulator
12 (57%) surveyed recognized misplacement of a portion of an implantable device
27 (49%) surveyed only mentioned the presence of an implantable device
15 (27%) surveyed did not mention an implantable device
For Question 2:
1 (2%) surveyed recognized the etiology of LOC as Epilepsy
20 (36%) surveyed mentioned syncope due to arrhythmia or device dysfunction
32 (58%) surveyed gave various other responses.
Of 17 attendings 12 (71%) were Internists, 3 neurologists, 1 radiology, 1 ER.
Question 1:
1 (6%) attending (neurology) recognized the presence of a vagus nerve stimulator
4 (24%) attendings commented on misplacement of a portion (wire) of an implantable device
9 (53%) attendings only mentioned the presence of an implantable device
3 (18%) attendings gave no mention of an implantable device
Question 2:
1 (6%) attending recognized the etiology of LOC as Epilepsy
8 (47%) attendings mentioned syncope due to arrhythmia or device dysfunction
8 (47%) attendings gave various other responses
Question 1:
0 (0%) residents recognized the presence of a Vagus nerve stimulator
8 (21%) residents recognized misplacement of some portion of an implantable device
18 (47%) residents only mentioned the presence of an implantable device
12 (32%) residents gave no mention of an implantable device
Question 2:
0 (0%) residents recognized the etiology of LOC as Epilepsy
12 (32%) residents mentioned syncope due to arrhythmia or device dysfunction
24 (63%) residents gave various other responses, There is a marked lack of recognition of the vagal nerve stimulator on chest x-ray among both attendings and residents regardless of medical specialty or level of training.
Due to the increasing numbers of patients treated with VNS for both epilepsy and depression as well as the importance of early recognition of the presence of a VNS implant, we suggest that more education about VNS is urgently required for primary care providers., (Supported by Cyberonics.)