Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study.
OBJECTIVE
To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED).


RESULTS
A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%). ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient loss of consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P < 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals.


CONCLUSIONS
Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.
Baron-Esquivias
Gonzalo
G
Department of Cardiology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot s/n., 41013 Sevilla, Spain. gbaron@jet.es
Martínez-Alday
Jesús
J
Martín
Alfonso
A
Moya
Angel
A
García-Civera
Roberto
R
Paz López-Chicharro
M
M
Martín-Mendez
María
M
del Arco
Carmen
C
Laguna
Pedro
P
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014474:Unconsciousness / Q000175:diagnosis* / Q000453:epidemiology*