It is estimated that up to 5% of hospital admissions are for evaluation of syncope. The etiology of syncope varies, and nonselective diagnostic evaluations to determine the cause of syncope are often inconclusive. We hypothesized that inpatient tests for syncope seldom provide additive information to achieve a correct diagnosis, especially in patients with suspected vasovagal syncope.
We retrospectively reviewed the medical records of consecutive adult patients with a principal diagnosis of syncope (ICD-9 Code 780.2) who were admitted through the emergency department of an 800-bed teaching hospital from January 1, 2000, through May 31, 2001. Two internists used standardized diagnostic criteria to determine the suspected cause of the syncope.
A total of 266 patients (44% women) with a mean age of 72±27 were identified. On admission, vasovagal syncope was suspected in 47% of the patients. Other suspected causes included cardiac (20), metabolic (10%), and neurological disorders (6%); in the remaining 17%, the cause of syncope remained unexplained. Overall yield of inpatient diagnostic tests were low (5-18%; Table
Frequency of Abnormal Results for Various Inpatient Diagnostic TestsAll patients presenting with syncope (n=266)Vasovagal etiology suspected on admission (n=126)Vasovagal etiology not suspected on admission (n=140)Cardiac, No. (%)Telemetry Monitoring12/229 (5)1/103 (1)*11/126 (9)Echocardiogram10/208 (5)1/99 (1)*9/109 (8)Stress Testing9/51 (18)1/22 (5)*8/29 (28)Tilt Table Testing8/14 (60)6/11 (55)2/3 (67)Neurological, No. (%)Brain CT Scan6/145 (4)1/62 (2)*5/83 (6)Electroence-phalography5/89 (6)1/31 (3)4/58 (7)Carotid Doppler4/60 (7)2/34 (6)2/26 (8)*
P<0.01, comparing the vasovagal to non-vasovagal group.). Of note, telemetry monitoring, echocardiogram, stress testing and brain CT scan was significantly lower yielding in patients with suspected vasovagal syncope.
Inpatient tests for syncope seldom achieve a correct diagnosis of syncope. Both cardiac and neurological tests are likely overused, especially when vasovagal syncope is suspected.
Unselected use of inpatient diagnostic techniques is not only inefficient but also unwarranted, especially when vasovagal syncope is suspected on initial evaluation.
S. Kohsaka, None.