How to recognize pulmonary embolism in syncope patients: A simple rule

Area of Science:

• Emergency Medicine
• Cardiology
• Pulmonology

Background:

• Syncope is a potential symptom of Pulmonary Embolism (PE).
• The utility of standardized algorithms to rule out PE in syncope patients presenting to Emergency Departments (ED) is unclear, with risks of overdiagnosis and overtreatment.

Purpose of the Study:

• To evaluate a simple clinical decision rule for identifying syncope patients with PE.
• To assess the rule's sensitivity and clinical impact in reducing diagnostic testing.

Main Methods:

• A multicenter observational study developed and tested a rule based on anamnestic and clinical parameters.
• Sensitivity was assessed in patients with syncope due to PE.
• Clinical impact was evaluated in consecutive syncope admissions to the ED.

Main Results:

• The rule identified patients with PE based on hypotension, tachycardia, low SpO2, chest pain, dyspnea, prolonged bed rest, DVT signs, prior VTE, or active cancer.
• The rule demonstrated a sensitivity of 90.3% for detecting PE.
• Applying the rule to 217 syncope patients could reduce the need for further diagnostic tests by 70%.

Conclusions:

• Most syncope patients with PE exhibit clinical features suggestive of the condition.
• A clinical decision rule can effectively identify patients requiring further PE exclusion tests.
• This approach can minimize unnecessary investigations, thereby reducing over-testing and over-diagnosis.