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Related Experiment Videos

Admission for syncope: evaluation, cost and prognosis.

M Schillinger1, H Domanovits, M Müllner

  • 1Department of Emergency Medicine, Vienna General Hospital, Medical School, Austria. mschillinger@hotmail.com

Wiener Klinische Wochenschrift
|December 1, 2000
PubMed
Summary

Syncope evaluation in the emergency department is costly and often inconclusive, with 38% of cases remaining unexplained. This suggests a need for more efficient diagnostic strategies for syncope patients.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Economics

Background:

  • Syncope diagnosis remains unexplained in up to 40% of patients despite thorough in-hospital assessment.
  • Emergency department admissions for syncope evaluation present significant challenges in diagnosis and cost.

Purpose of the Study:

  • To evaluate the diagnostic test application, hospital stay costs, and success rates for syncope patients admitted via the emergency department.
  • To determine the short-term prognosis of patients evaluated for syncope in a hospital setting.

Main Methods:

  • A retrospective cohort study analyzed 127 patients admitted for syncope evaluation between 1994 and 1998.
  • Systematic review of clinical history, physical examination, and diagnostic test findings.
  • Analysis of costs associated with diagnostic tests and hospital stay, with follow-up until December 1998.

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Main Results:

  • Patients underwent a median of 4 diagnostic tests over 12 days, with a median evaluation cost of 7,756 EUR per patient.
  • Hospital maintenance and care constituted the majority of costs (median 7,099 EUR).
  • Syncope remained unexplained in 38% of patients at discharge; diagnostic agreement between emergency department and discharge diagnoses was moderate (kappa = 0.49).

Conclusions:

  • Emergency department diagnosis influences syncope work-up but not overall evaluation cost.
  • The moderate diagnostic yield and high cost of in-hospital syncope evaluation necessitate exploring alternative strategies.
  • Patients exhibit a good short-term prognosis, with low mortality unrelated to syncope during hospitalization or within 30 days post-discharge.