title: Influence of age and gender on the occurrence and presentation of reflex syncope.
abstract: BACKGROUND
  The clinical history is the cornerstone of diagnosing patients with transient loss of consciousness (TLOC). Reflex syncope is the most common cause of TLOC in patients across all ages. Knowledge of the variation in incidence and clinical features of reflex syncope by age and gender provides important background information to acquire an accurate diagnosis.
  
  
  METHODS
  In a cohort of 503 patients presenting with TLOC we established a final diagnosis after systematic evaluation and two years of follow-up. The occurrence of prodromal signs, symptoms, and triggers in patients with reflex syncope was analyzed by both age (< 40 yrs, 40-59 yrs and > or = 60 years) and gender.
  
  
  RESULTS
  Reflex syncope was the most frequently obtained diagnosis (60.2%) in patients of all ages presenting with TLOC. Its occurrence was higher in patients under 40 years (73.4%), than above 60 years of age (45.3%). Pallor (79.9%), dizziness (73.4%), and diaphoresis (63.0%) were the most frequently reported prodromal signs and symptoms. Most triggers and prodromal signs and symptoms were more common in patients under 40 years of age and in women.
  
  
  CONCLUSIONS
  Reflex syncope is nearly twice as common in patients under 40 years of age than in patients aged 60 years or above. Typical signs and symptoms of reflex syncope are more common in younger patients and in women. Therefore, age and gender provide important diagnostic information and can help to decide whether additional testing is necessary.
authors.affiliation: Department of Clinical Epidemiology Biostatistics and Bioinformatics J1b-207-1, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.j.romme@amc.uva.nl
authors.forename: Jacobus J C M
authors.initials: JJ
authors.lastname: Romme
authors.forename: Nynke
authors.initials: N
authors.lastname: van Dijk
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Boer
authors.forename: Lukas R C
authors.initials: LR
authors.lastname: Dekker
authors.forename: Jan
authors.initials: J
authors.lastname: Stam
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Wouter
authors.initials: W
authors.lastname: Wieling
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology