Pulmonary embolism prevalence in syncope patients brought to the emergency room by ambulance

Abstract

Aim: Cohort studies have shown that syncope is one in four of the initial symptoms of acute pulmonary embolism. However, one in six patients who visit the emergency room for their first syncopal attack has acute pulmonary embolism. Additionally, the etiological relationship between acute pulmonary embolism and the possible prognostic impact of syncope on the early clinical course of a patient with acute pulmonary embolism remains unclear. Our research sought to detect the presence of pulmonary embolism and its contributing factors in syncope patients who were admitted to the emergency room. Material and Method: The study comprised 215 individuals who had syncope and were transported by ambulance to the emergency department between January 2020 and January 2021. The age bracket for inclusion was 18 to 75, and the presence of solitary syncope, regardless of its cause, was required. Additionally, there had to be no clinical signs of shock or hypotension, and/or absence of right ventricular dysfunction at presentation. Results: A total of 215 patients were included in the study. The mean age was 57 years and 64% of the patients were female. Pulmonary CT angiography was performed in 37 of the patients. Ventilation-perfusion examination was performed on 2 patients. Pulmonary embolism was confirmed in 14 patients, including a lower segment pulmonary embolism. Pulmonary embolism was diagnosed in 7 of 17 patients with no history of active cancer and a previous history of thromboembolism. The prevalence of pulmonary embolism was similar as predicted by the Wells score or Pulmonary Embolism Rule–Out Criteria in patients with low and moderate clinical probability. Conclusion: The results of this study confirm that pulmonary embolism is rarely found in patients admitted to the emergency department with syncope. Althoughpulmonary embolismshould be considered as a differential diagnosis, it does not need to be evaluated in all patients. Otherwise, assessment can lead to false positive results and overtreatment, thereby increasing adverse events and healthcare costs.