ED Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....

Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4)    Reed MJ.  The ROSE (Risk Stratification of syncope in the emergency department) Study.  J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049  Objectives: The aim of this study was to develop and validate a clinical decision rule (CDR) to predict 1-month serious outcome and all-cause death in patients presenting with syncope to the emergency department.  Background: Syncope is a common, potentially serious condition accounting for many hospital admissions.   Methods: This was a single center, prospective, observational study of adults presenting to the emergency department with syncope. A CDR was devised from 550 patients in a derivation cohort and tested in a validation cohort of a further 550 patients.  Results: One-month serious outcome or all-cause death occurred in 40 (7.3%) patients in the derivation cohort. Independent predictors were brain natriuretic peptide concentration greater than 300 pg/ml (odds ratio [OR]: 7.3), positive fecal occultblood (OR: 13.2), hemoglobin less than 90 g/l (OR: 6.7), oxygen saturation less than 94% (OR: 3.0)...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs