Diagnostic patterns in the evaluation of patients hospitalized with syncope

Syncope accounts for 5% of all hospital admissions. The etiology of syncope varies broadly, and nonselective, inpatient diagnostic evaluations to determine the cause of syncope are often inconclusive. We analyzed the yield of inpatient diagnostic tests for syncope, comparing patients with and without an initial suspected diagnosis of vasovagal syncope.

We retrospectively reviewed the medical records of consecutive adult patients with a principal diagnosis of syncope (ICD-9 Code 780.2) who were admitted through the emergency department of an 800-bed teaching hospital from January 1, 2000, to May 31, 2001.

A total of 267 patients (150 women, 117 men; mean age, 72.4 +/- 15.3 years) were identified. On admission, a diagnosis of vasovagal syncope was suspected in 47% of patients. Inpatient tests, including telemetry monitoring, echocardiography, and stress testing, were significantly lower yielding in patients with suspected vasovagal syncope when compared to patients with other suspected etiologies (P < 0.05).

Despite the significant length of hospital stay (median 4 days), we found that inpatient diagnostic workups for patients with suspected vasovagal syncope were low yielding, especially with regard to cardiac testing. Furthermore, abnormal test results did not change the discharge diagnosis.