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Routine or Protocol Evaluation of Trauma Patients With Suspected Syncope is Unnecessary

2011; Lippincott Williams & Wilkins; Volume: 70; Issue: 2 Linguagem: Inglês

10.1097/ta.0b013e31820958be

1529-8809

Adrian A. Maung, Lewis J. Kaplan, Kevin M. Schuster, Dirk C. Johnson, Kimberly A. Davis,

Heart Rate Variability and Autonomic Control

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.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.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.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.