Abstract
Objective
Current guidelines for evaluation of syncope recommend that in the absence of objective focal neurologic findings, head computed tomography (HCT) may not be necessary. Compliance with this recommendation is highly variable, which may be due in part to the lack of currently available evidence. We undertook the following investigation to determine whether HCT aids in the diagnostic investigation of syncope.
Methods
This study was a retrospective chart review of all adult patients who presented to an urban emergency department, and who had a HCT ordered for syncope, during a 6-month period in 2001. Patients with competing indications for HCT, or those with a presentation consistent with seizures were excluded. Charts were assigned to the “positive” or “negative” HCT group depending on whether the treating physician considered HCT findings relevant to the syncopal event.
Results
A total of 202 patients had a HCT performed for syncope. Eighty-five patients met one or more of the exclusion criteria. HCT of the remaining 117 patients were analyzed. None of the 117 patients had a HCT finding that was clinically related to the syncopal event.
Conclusions
HCT yielded no relevant clinical findings in our entire sample of patients with syncope. Our findings combined with previous studies add to the growing body of evidence that HCT for syncope in the absence of focal neurologic findings may not be necessary.
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References
Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS. A prospective evaluation and follow-up of patients with syncope.N Engl J Med 1983; 309: 197–204.
Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope.N Engl J Med 2002; 347: 878–85.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians.Ann Intern Med 1997; 126: 989–96.
Kapoor WN, Peterson J, Wieand HS, Karpf M. Diagnostic and prognostic implications of recurrences in patients with syncope.Am J Med 1987; 83: 700–8.
Linzer M, Felder A, Hackel A, et al. Psychiatric syncope: a new look at an old disease.Psychosomatics 1990; 31: 181–8.
Oh JH, Hanusa BH, Kapoor WN. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope?Arch Intern Med 1999; 159: 375–80.
Vaitkevicius PV, Esserwein DM, Maynard AK, O'Connor FC, Fleg JL. Frequency and importance of postprandial blood pressure reduction in elderly nursing-home patients.Ann Intern Med 1991; 115: 865–70.
Kapoor WN, Cha R, Peterson JR, Wieand HS, Karpf M. Prolonged electrocardiographic monitoring in patients with syncope. Importance of frequent or repetitive ventricular ectopy.Am J Med 1987; 82: 20–8.
Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope.Ann Emerg Med 1997; 29: 459–66.
Rubenstein JJ, Schulman CL, Yurchak PM, DeSanctis RW. Clinical spectrum of the sick sinus syndrome.Circulation 1972; 46: 5–13.
Ben-Chetrit E, Flugelman M, Eliakim M. Syncope: a retrospective study of 101 hospitalized patients.Isr J Med Sci 1985; 21: 950–3.
Kapoor WN. Evaluation and management of the patient with syncope.JAMA 1992; 268: 2553–60.
Giglio P, Bednarczyk EM, Weiss K, Bakshi R. Syncope and head CT scans in the emergency department.Emerg Radiol 2005; 12: 44–6.
Pires LA, Ganji JR, Jarandila R, Steele R. Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope.Arch Intern Med 2001; 161: 1889–95.
Kapoor WN. Evaluation and outcome of patients with syncope.Medicine (Baltimore) 1990; 69: 160–75.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians.Ann Intern Med 1997; 127: 76–86.
Brignole M, Alboni P, Benditt DG, et al., for the Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive summary.Eur Heart J 2004; 25: 2054–72
Heiken JP, Brink JA, Vannier MW. Spiral (helical) CT.Radiology 1993; 189: 647–56.
Rydberg J, Buckwalter KA, Caldemeyer KS, et al. Multisection CT: scanning techniques and clinical applications.Radiographics 2000; 20: 1787–806.
Davidson E, Rotenbeg Z, Fuchs J, Weinberger I, Agmon J. Transient ischemic attack-related syncope.Clin Cardiol 1991; 14: 141–4.
Day SC, Cook EF, Funkenstein H, Goldman L. Evaluation and outcome of emergency room patients with transient loss of consciousness.Am J Med 1982; 73: 15–23.
Eagle KA, Black HR. The impact of diagnostic tests in evaluating patients with syncope.Yale J Biol Med 1983; 56: 1–8.
Kapoor WN, Karpf M, Maher Y, Miller RA, Levey GS. Syncope of unknown origin. The need for a more cost-effective approach to its diagnosis evaluation.JAMA 1982; 247: 2687–91.
Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.JAMA 2005; 293: 2609–17.
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Goyal, N., Donnino, M.W., Vachhani, R. et al. The utility of head computed tomography in the emergency department evaluation of syncope. Int Emergency Med 1, 148–150 (2006). https://doi.org/10.1007/BF02936543
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DOI: https://doi.org/10.1007/BF02936543