Diagnostic evaluation of syncope in a tertiary hospital in Metro Manila: a retrospective study

Abstract

Background: Diagnostic evaluation of syncope is imperative to prevent disability, injury and sudden cardiac death. Work-ups and approach may differ due to geographical factors and the clinical setting where the patient is being managed. This study aims to determine the incidence and evaluation practices for syncope in a single private tertiary center in the Philippines. Methods: A 5-year retrospective study was done wherein records of patients admitted for loss of consciousness were reviewed on domains regarding initial evaluation, specialty referrals, ancillary procedures requested and final diagnosis upon discharge. Results: A total of 572 patients were included. The majority (93%) was referred to cardiology and/or neurology services. Aside from electrocardiogram (ECG), other most common work-ups requested were 2D echocardiogram, brain imaging via Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan, electroencephalogram (EEG) and 24-hour Holter monitoring- all of which has a low diagnostic yield (≤ 5%). The most common cause of syncope was neurally-mediated syncope (56%), followed by cardiac syncope (18%), orthostatic hypotension (10%), syncope mimics (7.3%), unspecified cause (7%) and psychogenic cause (1.5%). Conclusion: The incidences of syncope types in this southeast Asian population is consistent with previous findings from Western and other Asian countries. The low percent yield of additional diagnostic modalities to syncope work ups strengthens recommendations for a focused initial evaluation (pertinent history-taking, physical examination, electrocardiogram) to reduce unnecessary tests and exhaustion of resources in concordance with the latest international guidelines.