Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. The ECSIT study (epidemiology and costs of syncope in Trento).
BACKGROUND
The ECSIT study was aimed at evaluating the hospital management of syncope patients, at comparing the appropriateness and costs of the hospital diagnostic pathway before (phase 1) and after (phase 2) the introduction of new guidelines and at analyzing the physicians' compliance to the guidelines.


METHODS
All syncope patients admitted to the emergency room between August 1 and October 31, 1999 (phase 1) and between March 1 and May 31, 2000 (phase 2) were enrolled and their clinical records were analyzed in a blind fashion.


RESULTS
During the study 538 consecutive patients came to the emergency room for syncope with a hospitalization rate of 53% in phase 1 (n = 151) and of 42% in phase 2 (n = 107). The in-hospital stay increased from 9 days in phase 1 to 11.3 days in phase 2 and diagnostic tests from 2.6 per patient (phase 1) to 2.9 per patient (phase 2) with total costs that rose from [symbol: see text] 3,474 to [symbol: see text] 3,647. Patients with no diagnosis decreased from 51 to 45.8% and the principal causes were identified as vascular brain disease (36.1 vs 33.7%) and neurally-mediated mechanisms (35.3 vs 42.2%).


CONCLUSIONS
Despite the high costs of syncope management, the appropriateness and efficacy of the hospital diagnostic pathway remains far from ideal and simply introducing new guidelines seems unable to modify clinical practice.
Del Greco
Maurizio
M
Division of Cardiology, S. Chiara Hospital, Trento, Italy. DelGreco@tn.aziendasanitaria.trentino.it
Cozzio
Susanna
S
Scillieri
Marco
M
Caprari
Francesca
F
Scivales
Alessandro
A
Disertori
Marcello
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics / Q000592:standards; D003625:Data Collection; D019937:Diagnostic Techniques and Procedures / Q000191:economics* / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006767:Hospitals, District / Q000191:economics* / Q000592:standards*; D006769:Hospitals, General / Q000191:economics* / Q000592:standards*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000191:economics / Q000592:standards; D010865:Pilot Projects; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology