The US spends more than $750 billion/ yr on tests and procedures that do not benefit patients. Although there is no physiological indication for carotid ultrasound in “simple” syncope in the absence of focal neurological signs or symptoms suggestive of stroke, there is concern that this practice remains common for routine syncope workups.
We found that 16.5% of all Medicare beneficiaries with simple syncope underwent carotid imaging and 6.5% of all carotid ultrasounds ordered in 2009 were for this low‐value indication.
For the 15.4% patients with stenosis ≥50%, carotid ultrasound did not yield a causal diagnosis. Only 2% of patients imaged experienced a change in medications after a positive study, and <1% of patients underwent a carotid revascularization procedure.