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Cited by 118Cardiovascular Syncope and Autonomic DisordersEmergency and Acute Care StudiesVestibular and auditory disorders

Management of syncope referred urgently to general hospitals with and without syncope units

Open access
Brignole, M·2003·Europace
DOI 10.1016/s1099-5129(03)00047-3
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Abstract

OBJECTIVE: We tested the hypothesis that management of patients with syncope admitted urgently to a general hospital may be influenced by the presence of an in-hospital structured syncope unit. BACKGROUND: The management of syncope is not standardized. Methods We compared six hospitals equipped with a syncope unit organized inside the department of cardiology with six matched hospitals without such facilities. The study enroled all consecutive patients referred to the emergency room from 5 November 2001 to 7 December 2001 who were affected by transient loss of consciousness as their principal symptom. RESULTS: There were 279 patients in the syncope unit hospitals and 274 in the control hospitals. In the study group, 30 (11%) patients were referred to the syncope unit for evaluation. In the study group, 12% fewer patients were hospitalized (43 vs 49%, not significant) and 8% fewer tests were performed (3.3+/-2.2 vs 3.6+/-2.2 per patient, not significant). In particular, the study group patients underwent fewer basic laboratory tests (75 vs 86%, P=0.002), fewer brain-imaging examinations (17 vs 24%, P=0.05), fewer echocardiograms (11 vs 16%, P=0.04), more carotid sinus massage (13 vs 8%, P=0.03) and more tilt testing (8 vs 1%, P=0.000). In the study group, there was a +56% rate of final diagnosis of neurally mediated syncope (56 vs 36%, P=0.000). CONCLUSION: Although only a minority of patients admitted as an emergency are referred to the syncope unit, overall management is substantially affected. It is speculated that the use of a standardized approach, such as that typically adopted in the syncope unit, is able to influence overall practice in the hospital.

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  • Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates.

    “Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates (114–119).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [116]

    The Findings report fewer tests and hospitalizations in hospitals with syncope units, though the overall differences were not statistically significant. They also report more final diagnoses of neurally mediated syncope (56% versus 36%), but Table 3 does not show a comparable increase in the overall diagnostic rate: unexplained syncope was 16% versus 18%. The claim is supported for reduced service use and one diagnostic category, not for diagnostic rates generally. (LLM, conf=0.86)

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  • Results of lifestyle and medical therapies have generally been positive in uncontrolled and short-term controlled trials, but long-term placebo-controlled prospective trials have been less encouraging.

    “While results have generally been positive in uncontrolled trials and short-term controlled trials, those of long-term, placebo-controlled prospective trials have been less encouraging.”

    From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [116]

    The Findings and Discussion compare diagnostic management in hospitals with and without syncope units; the Conclusions discuss the need for further studies of those units. Searches for long-term placebo-controlled trials and for lifestyle or medical therapies found no passage comparing treatment-trial outcomes. (LLM, conf=0.77)

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Research works printed but not linked: 3

  1. [3]3. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in the clinical practice. Eur Heart J 2000; 21: 935-40.
  2. [8]8. ANMCO Task Force Report. Orientamenti sulla valutazione diagnostica dei pazienti con sincope. G Ital Cardiol 1995; 25: 937-48.
  3. [11]11. Linzer M, Yang E, Estes M, III, et al. Diagnos- ing syncope Part I: value of history, physical examina- tion, and electrocardiography. Ann Intern Med 1997; 126: 989-96.

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Authors
Brignole, M.
Affiliations
Presidio Ospedaliero (IT)
Corresponding author
Brignole, M
ORCID
Brignole, M
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2003-07
Volume
5
Issue
3
Pages
293-298
ISSN
1099-5129 (ISSN-L)
DOI
10.1016/s1099-5129(03)00047-3
OpenAlex
W2152746692
Cited by
118
References
11
Citations by year
2026: 3 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 6 · 2016: 3 · 2015: 10 · 2014: 10 · 2013: 10 · 2012: 4
FWCI
5.77
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
syncope, syncope unit, emergency department management, neurally mediated syncope, diagnostic testing, carotid sinus massage, tilt table test, hospital organization, standardization of care
MeSH terms
Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospital Units, Hospitals, General, Humans, Male, Middle Aged, Practice Patterns, Physicians', Referral and Consultation, Registries, Syncope

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