Syncope workup: Greater yield in select trauma population.

Area of Science:

• Trauma Care
• Cardiology
• Diagnostic Yield

Background:

• Syncope evaluation in trauma patients lacks standardized practice.
• Screening tests include electrocardiogram (ECG), echocardiogram (ECHO), and carotid duplex.
• Identifying high-yield investigations is crucial for efficient patient management.

Purpose of the Study:

• To determine the diagnostic yield of syncope screening studies in trauma patients.
• To identify patient characteristics that predict benefit from these investigations.
• To refine syncope evaluation protocols in trauma settings.

Main Methods:

• Retrospective cohort study of 736 trauma patients evaluated for syncope (2003-2015).
• Collected data on demographics, clinical findings, and interventions (pacemaker/defibrillator placement).
• Analyzed associations between comorbidities, positive findings, and interventions using STATA 14.

Main Results:

• Falls were the most common injury mechanism (82%).
• Congestive heart failure (CHF), coronary artery disease (CAD), and age ≥ 65 were linked to abnormal ECG/ECHO, not severe carotid stenosis.
• Elevated Injury Severity Score (ISS) predicted abnormal ECHO; abnormal ECG predicted abnormal ECHO (p=0.02).
• Only 1.4% received pacemakers/defibrillators (all with CHF); 1.7% had severe carotid stenosis.

Conclusions:

• Screening studies for syncope in trauma patients generally have low diagnostic yield.
• Routine carotid duplex ultrasound is not recommended.
• Cardiac evaluation should be personalized, focusing on patients with cardiac comorbidities, advanced age, and elevated ISS, with ECG as the initial screen.