title: Syncope as a health risk for soldiers - influence of medical history and clinical findings on the sensitivity of head-up tilt table testing.
abstract: BACKGROUND
  Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.
  
  
  METHODS
  Data from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation.
  
  
  RESULTS
  Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the electrocardiogram (ECG) patterns of patients showing syncope during tilt table testing.
  
  
  CONCLUSIONS
  Frequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.
authors.affiliation: The Practice of Dr. Jungblut, Frankfurt/Main, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Gilfrich
authors.affiliation: The Flight Medicine Clinic at Fassberg, German Armed Forces, Faßberg, Germany.
authors.forename: Lena Marie
authors.initials: LM
authors.lastname: Heidelmann
authors.affiliation: The Flight Medicine Clinic at Fassberg, German Armed Forces, Faßberg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Grube
authors.affiliation: The Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany.|The Department of Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Frickmann
authors.affiliation: The Practice of Dr. Jungblut, Frankfurt/Main, Germany.
authors.forename: Sven Andreas
authors.initials: SA
authors.lastname: Jungblut
keywords: Assessment; Head-up tilt testing; Hypotension; Predictor; Soldiers; Syncope