An Extensive Syncopal Workup for Geriatric Patients After a Traumatic Fall: Is It Worth It?

Area of Science:

• Geriatric Medicine
• Cardiology
• Neurology

Background:

• Syncope in geriatric patients with traumatic falls lacks clear diagnostic guidelines.
• A hypothesis suggests current inpatient workups, including echocardiograms and carotid duplex, are often excessive.

Purpose of the Study:

• To evaluate the necessity and yield of extensive inpatient syncope workups in elderly patients who have fallen.
• To determine if standard diagnostic tests can be safely reduced.

Main Methods:

• Retrospective review of 134 geriatric patients (≥65 years) with syncope and falls (Glasgow Coma Scale ≥14).
• Data collected included demographics, initial inpatient workup (ECG, cardiac monitoring, labs, TTE, carotid duplex), and interventions.
• Outcomes were measured by positive findings and treatment changes.

Main Results:

• 747 studies were performed on 134 patients.
• Only 2.3% of studies (17/747) yielded positive findings, impacting 9% of patients (12/134).
• 6% of patients (8/134) required treatment changes based on these findings.

Conclusions:

• Most syncope causes in this population are diagnosed via cardiac monitoring and ECG.
• Further testing like transthoracic echocardiogram (TTE) and carotid duplex can be deferred to outpatient settings.
• Tailoring workups based on initial assessment and ECG findings improves efficiency and reduces healthcare costs.