Utility of Routine Transthoracic Echocardiography in Hospitalized Syncope Patients Risk Stratified by EGSYS Score

Abstract

Utility of Routine Transthoracic Echocardiography in Hospitalized Syncope Patients Risk Stratified by EGSYS Score Background: The yield of routine transthoracic echocardiography (TTE) in the diagnosis and risk stratification of syncope has been a subject of debate. Purpose and Methods: To compare the yield of TTE in different risk categories of syncope patients, we performed a retrospective study of patients who had a TTE with an admission diagnosis of syncope. The patients were then stratified into low and high risk categories based on their Evaluation of Guidelines in Syncope Study (EGSYS) score of 3, respectively. Three downstream health resources were evaluated: cardiology consultation, further testing and therapeutic interventions after TTE was done. Results: Of the study group, 65% (295/456) of patients were found to have utilized no downstream health resources. The remaining 35% (161/456) had at least used 1 resource; 29.2% (133/456) utilized 1, 5% (23/456) utilized 2 and 1.1% (5/456) utilized all 3 of these resources. Of the total study group, 51% (233/456) were low risk for cardiac syncope according to the EGSYS score. Only 23.2% (54/233) of these low risk patients utilized 1 or more of the downstream health resources, but no patients in this group needed any cardiac intervention. Conclusion: There was a significant difference of the yield and thus incremental value of TTE between high and low risk group categories based on the EGSYS score. A low EGSYS score seems to be a good initial tool in identifying patients who likely will not require additional interventions related to further downstream testing.