Recognizing cardiac syncope in patients presenting to the emergency department with trauma.
BACKGROUND
Cardiac syncope is associated with poor outcomes and may result in traumatic injuries. In patients presenting to the emergency department (ED) with trauma, recognizing the cause of syncope is particularly challenging. Also, clinical markers to identify cardiac syncope are not well established.


OBJECTIVE
We sought to evaluate clinical markers that could identify cardiac syncope in patients with traumatic falls derived from a large urban trauma database.


METHODS
All patients presenting to the ED during a 10-year study period with a traumatic fall were identified retrospectively. The subset of patients with syncope was ascertained by chart review and defined as cardiac syncope (e.g., presence of dysrhythmia, valvular abnormality), non-cardiac syncope (e.g., vasovagal, neurological), or syncope of unknown cause.


RESULTS
Of the 5420 patients with traumatic falls, 180 (3.3%) patients with syncope were identified. Among the 180 patients with syncope, the cause was identified as cardiac in 24 (13%), noncardiac in 58 (32%), and unknown in 98 (54%). Three independent predictors (i.e., risk factors) of cardiac syncope were identified: age >65 years, presence of coronary artery disease, and pathological Q waves. Presence of at least one risk factor accurately predicted cardiac syncope in this population, with a sensitivity of 100%, a specificity of 43%, and a negative predictive value of 100% (area under the receiver operating characteristic curve: 0.80 ± 0.04).


CONCLUSIONS
In patients with traumatic falls and syncope, simple clinical and electrocardiographical variables may identify patients with cardiac causes of syncope. Proper identification of cardiac syncope in this population can potentially prevent recurrence of life-threatening traumatic injury.
Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio.
Pradeep K
PK
Bhat
Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio.
Ganesh
G
Pantham
Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio.
Sara
S
Laskey
Division of Trauma, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio.
John J
JJ
Como
Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio.
David S
DS
Rosenbaum
D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D004576:Electromyography; D004636:Emergency Service, Hospital; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology*; D014947:Wounds and Injuries / Q000209:etiology
cardiac syncope; dysrhythmia; falls; trauma