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The impact of diagnostic tests in evaluating patients with syncope
Insights
Extensive diagnostic testing for syncope is often unnecessary and costly. Focusing hospitalization on ruling out life-threatening arrhythmias, like those found in 12% of patients, is more beneficial.
Area of Science:
- Cardiology
- Neurology
Background:
- Syncope evaluation in hospitalized patients is common.
- Diagnostic testing strategies vary widely.
- The cost-effectiveness of extensive testing is often questioned.
Purpose of the Study:
- To evaluate the causes of syncope in hospitalized patients.
- To assess the utility and cost of diagnostic tests for syncope.
- To determine the most effective diagnostic approach for syncope.
Main Methods:
- Retrospective chart review of 100 patients admitted for syncope evaluation.
- Analysis of identified causes of syncope.
- Assessment of diagnostic test frequency, benefit, and cost.
Main Results:
- No etiology was found in 39% of patients; 18% had vasovagal syncope.
- Arrhythmias caused syncope in 12% of patients.
- Most diagnostic tests (e.g., brain scans, EEGs, Holter monitoring) provided limited additional information beyond history and physical exam, incurring significant costs.
Conclusions:
- Extensive neurologic testing is not warranted for routine syncope evaluations.
- Hospitalization for syncope should prioritize ruling out potentially life-threatening arrhythmias.
- A focused diagnostic approach is more cost-effective and clinically beneficial.
Abstract:
We reviewed the charts of 100 patients admitted to the hospital for evaluation of syncope. The charts were examined with special attention given to the causes of syncope, the frequency and benefit of diagnostic tests, and the relative cost of these tests. In 39 patients no etiology for syncope was found, and another 18 were felt to have had a vasovagal episode. Twelve patients had arrhythmias as the cause for syncope. Most of the patients underwent a variety of diagnostic tests including cardiac enzyme determinations, brain scans, electroencephalograms, head CAT scans, and Holter monitoring. In most instances, these tests added little useful information to the initial history and physical exam and were done at great expense to the patient. Our data suggest that extensive neurologic testing in patients with "routine" syncope is not warranted and that the focus of hospitalization should be to rule out potentially life-threatening arrhythmias.