Prognosis of Syncope With Head Injury: a Tertiary Center Perspective

Abstract

Aim: Head injury is the most common trauma occurring in syncope. We aimed to assess whether syncope as cause of head-trauma affects short-and long-term prognosis. Methods: From a database retrospective analysis of 97,014 individuals attending Emergency Department (ED), we selected data of patients with traumatic head injury including age, gender, injury mechanism, brain imaging, multiple traumas, bone fracture, intracranial bleeding, and mortality. Mean follow-up was 6.4 ± 1.8 years. Outcome data were obtained from a digital national population register. The study population included 3,470 ED head injury patients: 117 of them (50.0 ± 23.6 years, 42.7% men) reported syncope as cause of head trauma and 3,315 (32.2 ± 21.1 years, 68.5% men) without syncope preceding head trauma. Results: Thirty-day mortality was low and similar in traumatic head injury with or without syncope. One year and long-term all-cause mortality were both significantly higher in syncopal vs. non-syncopal traumatic head injury (11.1 vs. 2.8% and 32 vs. 10.2%, respectively; both p < 0.001). In adjusted logistic regression analysis, death between 121st-day and 1 year in patients with head-trauma was associated with male gender [odds ratio (OR): 6.48; 95% CI: 2.59-16.25], advancing age (per year) (OR 1.09; 95% CI 1.07-1.11), Glasgow Coma Scale < 13 (OR: 6.18; 95% CI:1.68-22.8), bone fracture (OR 4.72; 95% CI 2.13-10.5), and syncope (OR 3.70; 95% CI: 1;48-9.31). In multivariable Cox regression analysis, syncope was one of the strongest independent predictors of long-term all-cause death (hazard ratio: 1.95; 95% CI 1.37-2.78). Conclusion: In patients with head trauma, history of syncope preceding injury does not increase 30-day all-cause mortality but portends increased 1 year and long-term mortality.

Risk stratification of syncope: Current syncope guidelines and beyond

“…High-risk patients are dominantly those with cardiovascular conditions mentioned above that must be identified by careful physical examination and 12-lead ECG plus appropriate investigations. If this risk can be confidently ruled out, the focus moves to identifying causes and possible triggers of syncope with the aim of improving quality of life and preventing short/long-term adverse events associated with related trauma (Furtan et al, 2020) and associated medical conditions (Ricci et al, 2018). Low-risk and younger patients with reflex syncope have an excellent prognosis (Soteriades et al, 2002), while noncardiac/unexplained syncope combined with orthostatic hypotension (OH) in middleaged and older patients have been linked to a worse long-term outcome, mainly driven by age, severity of comorbidities, and may need hospital admission (Yasa et al, 2018;Ricci et al, 2018;Ruwald et al, 2013;Ricci et al, 2015;Ricci et al, 2017).…”

Evaluation of Patients with Syncope in the Emergency Department: How to Adjust Pharmacological Therapy

“…The prognosis varies with the type of syncope, with cardiac syncope being the most likely to lead to an increased risk of negative events [2]. Although the prognosis largely depends on the underlying cause of syncope, a syncope-related fall could be a relevant prognostic factor in all types of syncope [3][4][5][6].…”