Does the use of a syncope diagnostic protocol improve the investigation and management of syncope?

Abstract

The syncope protocol improved diagnosis and the use of appropriate investigations. However, significant inappropriate investigation and hospital admission still occurred. The protocol allowed reliable triage of syncopal patients into high and low risk groups.

Syncope Evaluation in the Emergency Department Study (SEEDS)

“…Despite efforts to develop a risk score, 16 diagnostic pathways, 12,13,36,38 and practice guidelines, 19 the hospital admission rate (for all patients presenting to an emergency department with a wide range of risk profiles and not limited to intermediate-risk patients) is high, ranging from 26% to 60%. 4,14,20,23,38,42 The high hospital admission rate for patients in the standard care group clearly reflects the difficulty in ascertaining which patients with syncope are at risk for an adverse event.…”

“…5,8 -13 These facts have led to the development of several diagnostic and triaging pathways [12][13][14][15][16] and clinical guidelines. 2,[17][18][19] Despite these efforts, extensive broad-based evaluations are performed and hospital admissions are frequent for patients presenting to an emergency department for syncope evaluation.…”

“…Several diagnostic protocols, pathways, and guidelines have been proposed to streamline the evaluation of syncope in both inpatient and outpatient settings. 2,[12][13][14][16][17][18][36][37][38] Despite these efforts, there is no uniform strategy. Clinical evidence for effective triage of patients in the emergency department who have syncope is limited.…”

Achieving High-Value Cardiac Imaging: Challenges and Opportunities

“…Compared with historical controls, the number of examinations needed to make a diagnosis decreased significantly, implying that the percentage of low yield echocardiograms was reduced. (47) Efforts to reduce low value imaging represent an important start in ensuring appropriate use of resources. Short term benefits are relatively easy to quantitate, at least economically in terms of dollars saved.…”

Different Types of Cardiac Arrhythmias Shown In Holter ECG Monitoring of 100 Patients Studied in NICVD

“…Holter monitoring is sixteen times more likely to be diagnostic for patients with cardiac syncope. 7 Ambulatory ECG has led to many new insights, including an understanding of the mechanisms of sudden cardiac death, causes of syncope and the concept of painless ischemia. 8 Gatzouliset al found that abnormal findings on 24-hour Holter monitoring are well correlated with potential bradycardia and/or tachyarrhythmia causes of syncope, in electrophysiological study of patients with undiagnosed syncope.…”