title: Routine or protocol evaluation of trauma patients with suspected syncope is unnecessary.
abstract: BACKGROUND
  Syncope is a commonly suspected cause of injury. Patients often undergo extensive testing without proven benefit. In this study, we investigated the utility of an inpatient syncope workup.
  
  
  METHODS
  A retrospective review was performed of all admissions to a Level I trauma center after fall or motor vehicle collision in patients older than 50 years and in whom syncope was suspected for the 3-year period ending December 2008. Demographics, diagnostic workup, number of abnormal results, and the frequency of subsequent interventions were recorded.
  
  
  RESULTS
  Two thousand one hundred seventy-one patients fulfilled study entry criteria; syncope was suspected in 302. The syncope and nonsyncope groups, respectively, were similar in age (76.9 years±12 years vs. 74.8 years±13 years) and female gender (58.3% vs. 58.4%) but differed in Injury Severity Score (7.4±5.7 vs. 9.7±7.7; p<0.01). Diagnostic workup commonly included electrocardiogram (89.4%), cardiac enzymes (88.7%), echocardiogram (78.8%), and carotid duplex or computed tomography angiography (64.9%). Significant abnormal results were uncommon: cardiac enzymes (2.9%), echocardiogram (3.8%), and carotid imaging (4.6%). Overall only 42 patients (13.9%) required further intervention, and in 29 patients (69%), the intervention was based on the initial history, physical examination, or admitting electrocardiogram.
  
  
  CONCLUSIONS
  Routine inpatient syncope workup has a low yield. Our data suggests that the diagnostic workup should be ordered based on clinical information rather than a standardized workup for all patients with suspected syncope.
authors.affiliation: Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06520, USA. adrian.maung@yale.edu
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Maung
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Schuster
authors.forename: Dirk C
authors.initials: DC
authors.lastname: Johnson
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D003955:Diagnostic Tests, Routine; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D013575:Syncope / Q000150:complications / Q000175:diagnosis*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology*