DIAGNOSTIC YIELD OF SYNCOPE INVESTIGATION (INITIATED) IN THE EMERGENCY DEPARTMENT: A PILOT STUDY

Abstract

Objective: To determine the diagnostic yield of investigations in patients presenting to the emergency department (ED) with syncope. To determine the cause of the syncope.Patients and methods: We retrospectively identified consecutive patients presenting to the ED who underwent investigations for syncope at a 1900 bed university teaching hospital during 4 months. From the medical records we abstracted clinical information, results of testing and the cause of syncope.Results: A total of 117 patients participated in the study. The mean age was 57 year (range 6-93 year), and 45% were male. Diagnostic procedures most often performed were blood analysis, ECG, chest X-ray and Holter monitoring (respectively in 94,1%, 88,8%, 74,4% and 36,8% of the patients). The corresponding diagnostic yield for these test was 4,5%, 6,7%, 0% en 16,3%. Other procedures were (% of patients; diagnostic yield): Ct scan of the head (35,1%; 0%), transthoracic echocardiogram (24,8%; 6,9%), ECG monitoring (24,8%; 27,6%), EEG (19,7%; 0%), neurovascular imaging (19.7%; 0%), abdominal ultrasound (11,1%; 0%), Ct scan of the chest (11,1%; 23,1%), head up tilt test (7,7%; 11,1%), carotid sinus massage (3,4%; 0%), pulmonary ventilation perfusion scintigraphy (2,6%; 33%) and exercise test (1,7%; 0%). The most common cause of syncope was neurocardiogenic (58,5% of patients), followed by orthostatic (11,1%), cardiac (11,1%), unknown (9,3%), hyperventilation (3,4%), pulmonary embolism (2,5%), drug related (2,5%) and others (1.7%).Conclusion: Patients admitted in the ED for syncope undergo various investigations. However, the diagnostic yield is poor. The most common cause of syncope is neurocardiogenic, followed by orthostatic and cardiac.