Predictor variables of abnormal imaging findings of syncope in the emergency department

Abstract

BackgroundThis study aimed to describe the pathological findings and to analyze clinical predictors of abnormal imaging findings in patients presenting to the emergency department (ED) with syncope.MethodsThe database was retrospectively reviewed for all patients who underwent cranial computed tomography (CT) or magnetic resonance imaging (MRI), having the symptom of syncope. Patients were included only if they were from the emergency department and excluded if were under 18 years of age, had known recent intracranial pathology, known brain tumor, or having a history of trauma. The primary outcome was assumed as abnormal head CT or MRI including intracranial hemorrhage, acute or subacute stroke, and newly diagnosed brain mass. Univariate and multivariate logistic regression analysis was utilized to determine the association between clinical variables and any significant pathology in either CT or MR scan.ResultsTotal of 1230 syncope (717 men and 513 women; range, 18–92 years; mean, 54.5 years) as presenting symptoms were identified in patients receiving either cranial CT or MR scan in the ED. Abnormal findings related to the syncope were observed in 47 (3.8%) patients. The following predictor variables were found to be significantly correlated with acutely abnormal head CT and MRI: a focal neurologic deficit, history of malignancy, hypertension, and age greater than 60 years.ConclusionsOur data offer that the identification of predictor variables has a potential to decrease the routine use of head CT and MRI in patients admitting to the ED with syncope.

Acil servisten istenen radyolojik görüntüleme incelemelerinin etkinliğinin değerlendirilmesi

“…Ozturk ve ark'ının 2018 yılındaki çalışmasında, senkopla acil servise başvuran hastalardan MRG veya BT istenenler incelenmiş, hastalardan sadece %3,8'inde görüntüleme sonucunda anormal patolojiler izlenmiştir. 16 Çalışmanın sonucunda senkopla acil servise başvuran hastalarda, kranial BT'lerin rutin kullanımında azalma sağlayacak yöntemlerin araştırılması gerektiği bildirilmiştir. Benzer şekilde, Kapoor ve ark'ı, senkop şikayetiyle acil servislere başvuran hastaların %4'ünde BT'nin fayda sağladığını ifade etmiştir.…”

Predictor variables of abnormal imaging findings of syncope in the emergency department

“…It might be difficult for emergency room doctors to recognize life-threatening illnesses. In over forty percent of cases, despite thorough inquiry, particular aetiology remained unknown (1).…”

“…Only few studies have looked at value of computed tomography & magnetic resonance imaging scans of head in determining severity of illnesses, despite fact that they are frequently used routinely. evaluation of studied cases admitted to ED with syncope can advance by identifying clinical & laboratory factors connected to these choices (2).…”

“…"Dizziness" has been described as "a sensation of unsteadiness accompanied by a feeling of movement within the head," "near-syncope" has been described as "the sensation of feeling faint," & "syncope" has been described as "a transient loss of consciousness and postural tone". For these studied cases, ED doctor must make very broad differential diagnosis, & clinical picture is frequently complicated by coexisting conditions, polypharmacy, & symptom communication challenges (1).…”

“…Out of forty-four studied cases with syncope who received head CT on ED orders, 1 studied case had indications of an infarction. After removing studied cases with persistently changed mental status, drugrelated or post-traumatic loss of consciousness, seizure, or hypoglycemia, diagnostic yield of five percent aberrant head CT findings is also required (1).…”