Syncope Evaluation: Evidence-Based and Economical

This study eliminated low-risk syncope patients and those with non-syncope transient loss of consciousness, such as seizure and head trauma, using a structured approach in the emergency department (ED), with only high-risk syncope patients being admitted. These high-risk syncope patients made up 28% of the patients included in the study. After admission, a simplified Wells’ pulmonary embolism criteria score was calculated, and a D-dimer was obtained. If either was high, the patient was scanned for PE and 17% were found to be positive, with two-thirds of those being found to have large-vessel pulmonary emboli. The bottom line of this study was that only 4% of the ED presentations for syncope after a structured workup had a PE. Subsequent meta-analysis showed a much lower prevalence of PE in patients admitted with syncope at 0.5 to 2.0%. In the U.S., the rate of admission for syncope was 78% whereas it was 28% in PESIT, likely due to a more structured ED workup. Dr. Dressler shared the pearl that he obtains a D-dimer after admission if the etiology is still unclear, which occurs in about 10% of the patients that he admits with syncope. The best-validated risk-scoring tool for syncope is the Canadian Syncope Risk Score, which came out in 2016 and identifies patients at risk for serious adverse events (death, myocardial infarction, arrhythmia, structural heart disease, aortic dissection, PE, severe pulmonary hypertension, subarachnoid hemorrhages, or serious condition requiring...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Clinical Guidelines Source Type: research