Syncope of unknown origin. The need for a more cost-effective approach to its diagnosis evaluation

Abstract

The records of 121 patients hospitalized in Presbyterian-University Hospital, Pittsburgh, during 1976 to 1980 for syncope of unknown origin were reviewed. The were 58 men and 63 women, whose mean age was 63.1 years. Cardiac monitoring in 67 patients showed abnormalities in seven patients, considered diagnostic of the cause of syncope. In 13 patients with electrophysiologic studies, four patients had abnormal results, suggesting a probable cause for the syncope. Cardiac catheterization in 14 patients showed significant findings that demonstrated the cause of syncope in three patients. Glucose tolerance tests in 37 patients, head computed tomographic scans in 39 patients, radionuclide brain scans in 15 patients, lumbar punctures in 22 patients, and skull roentgenograms in 46 patients did not aid in the diagnosis of the cause of syncope in any patient. In 67 patients, EEGs produced abnormal results in 26, but the role of EEGs in the diagnostic workup of syncope could not be completely defined. The definitive cause for syncope was diagnosed in only 13 of 121 patients, with an average hospitalization of nine days and an average cost of $2,463 per patient. These findings suggest that an extensive evaluation of syncope is cost--ineffective and that prospective goal-directed approaches need to be developed.

Guidelines on management (diagnosis and treatment) of syncope

“…A study in 1982 showed that patients often underwent multiple diagnostic tests despite which a cause of syncope was established in only 13 of 121 patients [44] . With the advent of newer diagnostic tests (e.g.…”

“…The possible contribution of the EEG is to disclose epileptiform abnormalities; there are no specific EEG findings for any loss of consciousness other than epilepsy. Accordingly, several studies [27,44,[260][261][262][263] conclusively showed that electroencephalographic monitoring was of little use in unselected patients with syncope (level B). Thus, electroencephalography is not recommended for patients in whom syncope is a priori the most likely cause for a transient loss of consciousness; it is beneficial in patients with a relatively high likelihood of epilepsy, such as a history of seizures.…”

“…Early case series of such patients [19,27,44,244,261] found that computed tomography produced new information only …”

Incidence of immediate adverse reaction of blood donation

“…ese studies have found that youth, low weight, rst-time donor status, and past vaso-vagal reaction increase the probability of having a vaso-vagal reaction, but they are not predictive. 13,14 is study was aimed to explore the incidence of adverse reactions after blood donation including the incidence vaso-vagal reaction among the whole blood donors.…”

Syncope Evaluation at a Crossroad

“…2,8,9 Unfortunately, the approach often undertaken includes low-yield testing (EEG, CT scan, carotid Dopplers, Holter monitor, and cardiac enzymes), 2,4,10 yet even "proper" testing (electrophysiology testing and tilt table testing) can be fruitless. In nearly half of all patients, no diagnosis is secured.…”