["Malaise" at an emergency department. Diagnostic approach]

From a prospective study of 152 patients admitted to an emergency department on account of "malaise" (i.e. dizziness with or without syncope), the authors have extracted a number of interesting points. After 24 hours under observation with questioning, physical examination and measurement of blood alcohol, glucose and carbon dioxide levels, the cause of the "malaise" could be determined in 84 per cent of the patients. Among 37 patients who were detained for more than 24 hours, only 3 additional diagnoses were made. Patients with syncope had the same cause of dizziness as those without syncope. One hundred and nineteen patients were followed up for one year. The mortality rate in patients with a cardiovascular cause of "malaise" was significantly higher than in patients with other causes. Patients with dizziness of unknown origin had the same mortality rate. Patients of more than 70 years of age had a mortality rate (50 per cent) significantly higher than that of patients aged less than 70 (25 per cent). Finally, the patient's history and physical examination proved to be the most helpful aids in establishing the cause of the "malaise".