Syncope: Diagnostic Yield of Various Clinical Investigations

Diagnostic utility and outcomes of inpatient investigations for syncope in a regional setting

“…Telemetry ECG was performed in 75% of patients and led to the diagnosis of syncope in 9.6% of patients, which is a similar rate to that demonstrated in a comparable observational study. 8 Studies suggest that the diagnostic yield of ambulatory cardiac monitoring increases with duration, 1 which notably relates to the outcome observed in 17 patients of loop recorded insertion. Although telemetry ECG did not lead to the diagnosis of syncope in 90% of patients, its importance as an inpatient investigation for syncope can be argued.…”

“…This rate of TTE is similar to that performed in other studies, however with a slightly better yield rate than 2%-3%. 8 The 2017 American College of Cardiology/American Heart Association guidelines recommend TTE for patients with unexplained syncope when the initial evaluation suggests a cardiovascular abnormality. 3 This was supported by a previous prospective study that found that TTE revealed positive findings in 27% of syncope patients with a cardiac history or abnormal ECG, versus 0% in syncope patients without a cardiac suspicion.…”

“…Previous retrospective cohort studies suggested that carotid ultrasounds were normal in approximately 90% of patients with syncope and, therefore, offer a low diagnostic yield in the work-up for syncope. 8,10,15 CT head non-contrast was performed in 58.8% of patients but did not lead to a syncope diagnosis in any patients. Similarly, MRI brain was performed in 3.9% of patients and also did not lead to the diagnosis of syncope in any of these patients.…”

Does head CT imaging assist in the diagnosis of an adult with syncope?

“…A prospective randomized controlled trial (RCT) examined the effectiveness of POCUS integration on diagnostic reasoning. 3 Three clinical case scenarios describing acute dyspnea presentations were…”

“…A 2022 cross-sectional, observational study of 90 consecutive patients (more than 12 years old) presenting with syncope, compared the utility of head imaging (CT/MRI) versus nonimaging modalities (eg, physical examination, history, EKG) on finding the etiology of syncope. 3 Overall, 36% (n533) of the study population received a head CT/MRI, but only 24% (n58) of the CT head tests had abnormal results. However, the authors noted that these abnormal results did not assist diagnosing the cause of syncope.…”