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Related Experiment Videos

Prospective evaluation of syncope.

G J Martin, S L Adams, H G Martin

    Annals of Emergency Medicine
    |July 1, 1984
    PubMed
    Summary
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    Syncope evaluation in the emergency department found vasovagal syncope most common. Cardiac syncope had a shorter warning period, and serum bicarbonate levels may aid seizure diagnosis.

    Area of Science:

    • Emergency Medicine
    • Cardiology
    • Neurology

    Background:

    • Syncope is a common presentation to emergency departments, posing diagnostic challenges.
    • Accurate etiological diagnosis is crucial for appropriate management and prognosis.

    Purpose of the Study:

    • To prospectively investigate the causes of syncope in emergency department patients.
    • To compare clinical features, particularly the warning period, across different syncope etiologies.
    • To evaluate the utility of diagnostic tests in identifying syncope causes.

    Main Methods:

    • Prospective study of 170 patients presenting with syncope.
    • Utilized a checklist to supplement physician history and physical examination.
    • Categorized patients by presumed etiology with specific diagnostic criteria.

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  • Mean follow-up of 6.2 months in 89% of patients.

    • Main Results:

    • Vasovagal syncope was the most frequent diagnosis (37.1%).
    • Other significant etiologies included first seizure (8.8%), orthostasis (7.6%), and cardiac syncope (4.1%).
    • Syncope of unknown etiology accounted for 37.6% of cases.
    • Cardiac syncope patients had significantly shorter warning periods than vasovagal syncope patients.
    • Serum bicarbonate was decreased in 70% of seizure patients, showing diagnostic utility.

    Conclusions:

    • Vasovagal syncope is the predominant cause of syncope in the emergency department setting.
    • Cardiac syncope warrants prompt recognition due to potentially shorter warning periods.
    • Routine laboratory tests have limited yield, except for serum bicarbonate in suspected seizures.
    • Recommendations for initial evaluation and admission strategies are proposed.