ACR Appropriateness Criteria® Syncope

Area of Science:

• Cardiology
• Neurology
• Radiology

Background:

• Syncope and presyncope account for over a million US emergency room visits annually.
• Determining the cause is complex due to varied etiologies, ranging from benign vasovagal syncope to life-threatening cardiac causes.
• While history and physical exam are primary, imaging aids diagnosis in specific clinical contexts.

Framework:

• The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for imaging in syncope and presyncope.
• These guidelines are developed through rigorous analysis of medical literature and expert consensus.
• Methodologies like RAND/UCLA and GRADE inform the recommendations for imaging procedures.

Implementation:

• Resting transthoracic echocardiography is often appropriate for initial cardiac imaging when a cardiovascular etiology is suspected.
• Chest radiography may be considered in specific clinical situations, particularly when cardiac or neurologic pathology is unlikely.
• Imaging is guided by clinical presentation, physical examination, and electrocardiogram (ECG) findings.

Implications:

• Appropriate use of imaging can help differentiate between benign and serious causes of syncope.
• Guidelines aid clinicians in selecting the most suitable imaging studies, optimizing patient care.
• Accurate diagnosis through appropriate imaging is crucial for managing the risk associated with potentially fatal etiologies.