This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (19)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Diagnosis  • Cardiac Diagnostic Tests  • Alert me on articles by topic  Social Bookmarking   What's this?

Luis A. Pires, MD; Jangadeesh R. Ganji, MD; Regina Jarandila, RN; Robert Steele, MD

Arch Intern Med. 2001;161:1889-1895.

Background  Syncope is a common clinical problem that is often difficult and expensive to diagnose. We examined diagnostic patterns and trends and use of specialty consultations in the evaluation of syncope.

Methods  We retrospectively reviewed the medical records of consecutive adult patients hospitalized with the principal diagnosis of syncope (International Classification of Diseases, Ninth Revision, code 780.2) during 1994 and 1998 at 2 community teaching hospitals.

Results  A total of 649 patients (57% female) with a mean (±SD) age of 68 ± 15 years were identified in 1994 (n = 451) and 1998 (n = 198). Three hundred forty-one patients (53%) underwent at least 1 neurologic test, including brain computed tomographic (CT) scan (n = 283), electroencephalography (n = 253), carotid Doppler echocardiography (n = 185), and brain magnetic resonance imaging (n = 10). Only brain CT scan and electroencephalography yielded diagnoses in 5 (2%) and 6 patients (2%), respectively with history consistent with seizures or stroke. Cardiovascular tests providing the highest diagnostic yields (postural blood pressure check in 52 [30%], head-up tilt-table test in 32 [24%], and electrophysiologic study in 5 [16%]) were used in 176 (27%), 132 (20%), and 31 patients (5%), respectively. Differences in the use of some tests were noted at the participating hospitals and over time (1994 vs 1998). The total number of diagnosed cases was similar for patients undergoing evaluation by primary care physicians alone (65/103 [63%]), compared with cardiology (48/85 [56%]), neurology (29/48 [60%]), or both (81/141 [57%]). After a mean (±SD) length of stay of 5 ± 4 days, 320 (49%) of 649 cases remained undiagnosed.

Conclusions  Despite a reduction in the use of some tests (eg, brain CT scan and carotid Doppler) over time, lower-yield neurologic tests were overused and higher-yield cardiovascular tests were likely underused. The untargeted, seemingly random use of specialty evaluations did not seem to contribute to an increase in the overall number of diagnosed cases. Increased use of specific tests directed by history and results of physical examination may improve diagnostic yield and decrease the cost of evaluating syncope.

From the Division of Cardiology, Department of Medicine, St John Hospital and Medical Center, Sinai-DMC, and Wayne State University School of Medicine, Detroit, Mich.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(15):1929-1930.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Diagnostic Yield and Utility of Neurovascular Ultrasonography in the Evaluation of Patients With Syncope
Schnipper et al.
Mayo Clin Proc. 2005;80:480-488.
ABSTRACT  

Syncope Evaluation in the Emergency Department Study (SEEDS): A Multidisciplinary Approach to Syncope Management
Shen et al.
Circulation 2004;110:3636-3645.
ABSTRACT | FULL TEXT