title: The prevalence of Neurally Mediated Syncope in older patients presenting with unexplained falls.
abstract: OBJECTIVE
  To determine the prevalence and clinical significance of carotid sinus syndrome (CSS) and vasovagal syncope (VVS), the two common types of Neurally Mediated Syncope (NMS), in a cohort of older patients with unexplained falls.
  
  
  METHODS
  Patients presenting with unexplained and accidental falls were identified from 200 consecutive admissions of falls in patients aged 65 years and older admitted to the Rapid Assessment Medical Unit (RAMU) in a teaching hospital. A sample of unexplained and accidental fallers underwent carotid sinus massage (CSM) and tilt table testing (TTT) as per a standardised protocol. Baseline characteristics, clinical variables and the prevalence of NMS were compared between the two groups.
  
  
  RESULTS
  Falls were unexplained in 26% of patients. The prevalence of NMS was 24% (5/21) among patients with unexplained falls who underwent assessment for NMS, whereas it was nil (0/17) in patients with accidental falls (P=0.050). The prevalence of previous falls was significantly higher in patients with unexplained falls (P=0.0025), but all other baseline characteristics were similar between the two groups.
  
  
  CONCLUSIONS
  Falls are unexplained in a significant number of older patients presenting to acute hospitals. The assessment of unexplained fallers for NMS is clinically important as this may be aetiologically related in nearly a quarter of these patients.
authors.affiliation: Department of General Medicine, Western Hospital, Melbourne, Victoria 3011, Australia. Mahesan.Anpalahan@wh.org.au
authors.forename: Mahesan
authors.initials: M
authors.lastname: Anpalahan
authors.forename: Stephen
authors.initials: S
authors.lastname: Gibson
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D003952:Diagnostic Imaging; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000453:epidemiology*; D018667:Tilt-Table Test; D014739:Victoria / Q000453:epidemiology