The utility of head computed tomography in the emergency department evaluation of syncope.
OBJECTIVE
Current guidelines for evaluation of syncope recommend that in the absence of objective focal neurologic findings, head computed tomography (HCT) may not be necessary. Compliance with this recommendation is highly variable, which may be due in part to the lack of currently available evidence. We undertook the following investigation to determine whether HCT aids in the diagnostic investigation of syncope.


METHODS
This study was a retrospective chart review of all adult patients who presented to an urban emergency department, and who had a HCT ordered for syncope, during a 6-month period in 2001. Patients with competing indications for HCT, or those with a presentation consistent with seizures were excluded. Charts were assigned to the "positive" or "negative" HCT group depending on whether the treating physician considered HCT findings relevant to the syncopal event.


RESULTS
A total of 202 patients had a HCT performed for syncope. Eighty-five patients met one or more of the exclusion criteria. HCT of the remaining 117 patients were analyzed. None of the 117 patients had a HCT finding that was clinically related to the syncopal event.


CONCLUSIONS
HCT yielded no relevant clinical findings in our entire sample of patients with syncope. Our findings combined with previous studies add to the growing body of evidence that HCT for syncope in the absence of focal neurologic findings may not be necessary.
Goyal
Nikhil
N
Department of Emergency Medicine, Henry Ford Hospital, 2799 W Grand Blvd, CFP-2, Detroit, MI 48226, USA. ng@spandan.com
Donnino
Michael W
MW
Vachhani
Ravi
R
Bajwa
Ravi
R
Ahmad
Tabassum
T
Otero
Ronny
R
D000328:Adult; D003625:Data Collection; D004636:Emergency Service, Hospital; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed