title: Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot study.
abstract: OBJECTIVE
  To determine the diagnostic yield of investigations in patients presenting to the emergency department (ED) with syncope. To determine the cause of the syncope.
  
  
  METHODS
  We retrospectively identified consecutive patients presenting to the ED who underwent investigations for syncope at a 1900 bed university teaching hospital during 4 months. From the medical records we abstracted clinical information, results of testing and the cause of syncope.
  
  
  RESULTS
  A total of 117 patients participated in the study. The mean age was 57 year (range 6-93 year), and 45% were male. Diagnostic procedures most often performed were blood analysis, ECG, chest X-ray and Holter monitoring (respectively in 94.1%, 88.8%, 74.4% and 36,8% of the patients). The corresponding diagnostic yield for these test was 4.5%, 6.7%, 0% and 16.3%. Other procedures were (% of patients; diagnostic yield): Ct scan of the head (35.1%; 0%), transthoracic echocardiogram (24.8%; 6.9%), ECG monitoring (24.8%; 27.6%), EEG (19.7%; 0%), neurovascular imaging (19.7%; 0%), abdominal ultrasound (11.1%; 0%), Ct scan of the chest (11.1%; 23.1%), head up tilt test (7.7%; 11.1%), carotid sinus massage (3.4%; 0%), pulmonary ventilation perfusion scintigraphy (2.6%; 33%) and exercise test (1.7%; 0%). The most common cause of syncope was neurocardiogenic (58,5% of patients), followed by orthostatic (11.1%), cardiac (11.1%), unknown (9.3%), hyperventilation (3.4%), pulmonary embolism (2.5%), drug related (2.5%) and others (1.7%).
  
  
  CONCLUSIONS
  Patients admitted in the ED for syncope undergo various investigations. However, the diagnostic yield is poor.The most common cause of syncope is neurocardiogenic, followed by orthostatic and cardiac.
authors.affiliation: Emergency Department, University Hospital Leuven, Leuven, Belgium. peter.vanbrabant@uzleuven.be
authors.forename: P
authors.initials: P
authors.lastname: Vanbrabant
authors.forename: V
authors.initials: V
authors.lastname: Van Ouytsel
authors.forename: D
authors.initials: D
authors.lastname: Knockaert
authors.forename: J B
authors.initials: JB
authors.lastname: Gillet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology; D002648:Child; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data; D003943:Diagnostic Techniques, Neurological / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009422:Nervous System Diseases / Q000150:complications / Q000503:physiopathology; D010865:Pilot Projects; D011859:Radiography; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013575:Syncope / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D014463:Ultrasonography