To evaluate the workup of patients admitted to the hospital with syncope and to evaluate that clinical practice guidelines for syncope were followed.
We retrospectively reviewed medical records of 104 patients (50 males, 54 females, age range 23-93; mean age 63.8 yrs) with the principal diagnosis of syncope over a period of 6 months and examined their initial diagnostic workup including CT-head and carotid Doppler ultrasound.
Only one patient had focal neurological deficit on initial presentation. Both his carotid ultrasound and CT-head were abnormal. 55 (52.8%) patients had carotid doppler ultrasound and 62 (59.6%) patients had CT-head despite normal physical examination; both tests were normal.
These data suggest that the use of imaging studies in the evaluation of syncope has a low diagnostic yield. Careful history, and physical examination should help guide diagnostic testing.
The use of published clinical guidelines for syncope is a good tool for the diagnostic workup. Patients with no focal neurologic deficit on physical examination are unlikely to benefit from radiological imaging.
M. Ismail, None.