title: Clinical aspects and diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls.
abstract: OBJECTIVE
  To evaluate the diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls compared to those with a syncope etiologically unexplained after initial evaluation.
  
  
  METHODS
  It is an observational study, comparing 298 patients with unexplained fall with 989 patients with unexplained syncope. Each patient underwent supine and upright blood pressure measurement, tilt testing (TT) and carotid sinus massage (CSM).
  
  
  RESULTS
  Patients with unexplained falls were older (75.3 ± 11.1 vs. 63.2 ± 19.2 years, p < 0.001), were more frequently hypertensive (66.1 vs. 47.2 %, p < 0.001) and more frequently prescribed antihypertensive drugs (62.4 vs. 48.7 %, p < 0.001) or benzodiazepines (15.7 vs. 10.6 %, p = 0.01), and in a greater proportion they experienced major traumatic injuries (77.5 vs. 29.6 %, p < 0.001) as a consequence of falls. The TT was less frequently positive in patients with unexplained falls (36 vs. 51.3 %, p < 0.001), whereas a Carotid Sinus Syndrome as suggested by CSM had a similar prevalence in the two groups (14.3 vs. 10.5 %, p = 0.074). Overall, either TT or CSM were positive in 61 % of patients with unexplained falls, and in 64 % of those with syncope (p = 0.346). After matching by age 298 patients with falls (75.3 ± 11.1 years) and 298 patients with unexplained syncope (75.4 ± 11.1 years), we found that the positivity prevalence of TT and CSM were similar in the two groups.
  
  
  CONCLUSIONS
  The positivity prevalence of TT and CSM in patients with unexplained falls compared to patients with unexplained syncope is similar. Given its high diagnostic relevance, the neuroautonomic evaluation should be routinely performed in older patients with unexplained falls.
authors.affiliation: Syncope Unit, Division of Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rafanelli
authors.forename: E
authors.initials: E
authors.lastname: Ruffolo
authors.forename: V M
authors.initials: VM
authors.lastname: Chisciotti
authors.forename: M A
authors.initials: MA
authors.lastname: Brunetti
authors.forename: A
authors.initials: A
authors.lastname: Ceccofiglio
authors.forename: F
authors.initials: F
authors.lastname: Tesi
authors.forename: A
authors.initials: A
authors.lastname: Morrione
authors.forename: N
authors.initials: N
authors.lastname: Marchionni
authors.forename: A
authors.initials: A
authors.lastname: Ungar
mesh_terms: D000058:Accidental Falls; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002346:Carotid Sinus / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013575:Syncope / Q000503:physiopathology; D018667:Tilt-Table Test / Q000379:methods