Routine or protocol evaluation of trauma patients with suspected syncope is unnecessary

Document Type

Article

Publication Title

The Journal of trauma

Abstract

BACKGROUND: Syncope is a commonly suspected cause of injury. Patients often undergo extensive testing without proven benefit. In this study, we investigated the utility of an inpatient syncope workup. METHODS: A retrospective review was performed of all admissions to a Level I trauma center after fall or motor vehicle collision in patients older than 50 years and in whom syncope was suspected for the 3-year period ending December 2008. Demographics, diagnostic workup, number of abnormal results, and the frequency of subsequent interventions were recorded. RESULTS: Two thousand one hundred seventy-one patients fulfilled study entry criteria; syncope was suspected in 302. The syncope and nonsyncope groups, respectively, were similar in age (76.9 years±12 years vs. 74.8 years±13 years) and female gender (58.3% vs. 58.4%) but differed in Injury Severity Score (7.4±5.7 vs. 9.7±7.7; p<0.01). Diagnostic workup commonly included electrocardiogram (89.4%), cardiac enzymes (88.7%), echocardiogram (78.8%), and carotid duplex or computed tomography angiography (64.9%). Significant abnormal results were uncommon: cardiac enzymes (2.9%), echocardiogram (3.8%), and carotid imaging (4.6%). Overall only 42 patients (13.9%) required further intervention, and in 29 patients (69%), the intervention was based on the initial history, physical examination, or admitting electrocardiogram. CONCLUSION: Routine inpatient syncope workup has a low yield. Our data suggests that the diagnostic workup should be ordered based on clinical information rather than a standardized workup for all patients with suspected syncope.

First Page

428

Last Page

32

DOI

10.1097/TA.0b013e31820958be

Publication Date

2-1-2011

Identifier

21307745 (pubmed); 10.1097/TA.0b013e31820958be (doi); 00005373-201102000-00027 (pii)

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