The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.
The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units
Open accessAbstract
BACKGROUND: The appropriate diagnostic work-up of patients with syncope is not well defined. We applied the guidelines of Italian 'Associazione Nazionale Medici Cardiologi Ospedalieri' to a group of consecutive patients with syncope referred to three Syncope Units. The aim of the study was to evaluate the applicability of those guidelines in the 'real world' and their impact on the use of the tests. METHODS: We evaluated 308 consecutive patients with syncope (mean age 61 +/- 20 years; median of three syncopal episodes per patient). The hierarchy and appropriateness of diagnostic tests and the definitions of the final diagnosis followed standardized predefined criteria. In brief, all patients underwent initial evaluation consisting of history, physical examination, supine and upright blood pressure measurement and standard electrocardiogram (ECG) (only in patients > 45 years or with history of heart disease). Any subsequent investigations were based on the findings of the initial evaluation. Priority was given to cardiological tests (prolonged ECG monitoring, exercise test, electrophysiological study), or to neurally mediated tests (carotid sinus massage, tilt test, ATP test), or to neuro-psychiatric tests, as appropriate. FINDINGS: The initial evaluation alone was diagnostic in 72 patients (23%). One further test was necessary for diagnosis in 65 patients (21%), > or = 2 tests in 64 (21%) and > or = 3 tests in 50 (16%). The diagnostic yield was 10% for ECG, 3% for echocardiogram, 16% for Holter, 5% for exercise test, 27% for electrophysiological study, 57% for carotid sinus massage, 52% for tilt testing and 15% for ATP test. At the end of the work-up the mechanism of syncope remained unexplained in 57 patients (18%). CONCLUSIONS: When standardized criteria based on the appropriateness of indications are used, few simple tests are usually needed for diagnosis of syncope.
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“Although the diagnostic yield of ECG monitoring varies from 1.9-17.6%, 158-160 it is justified by the need to avoid immediate risk to the patient.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [160]
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“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 [115]
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Cites
Guidelines on management (diagnosis and treatment) of syncope
Brignole, M. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2739 · Cited by 951
A Prospective Evaluation and Follow-up of Patients with Syncope
Kapoor, W. N., Karpf, M., Wieand, S., Peterson, J. R., & Levey, G. S. (1983) · New England Journal of Medicine · doi:10.1056/nejm198307283090401 · Cited by 779
Almquist, A. K., Goldenberg, I. F., Milstein, S., Chen, M. Y., Chen, X., Hansen, R., Gornick, C. C., & Benditt, D. G. (1989) · New England Journal of Medicine · doi:10.1056/nejm198902093200603 · Cited by 644
Evaluation and outcome of emergency room patients with transient loss of consciousness
Day, S. C., Cook, E. F., Funkenstein, H., & Goldman, L. (1982) · The American Journal of Medicine · doi:10.1016/0002-9343(82)90913-5 · Cited by 587
Diagnostic value of history in patients with syncope with or without heart disease
Alboni, P., Brignole, M., Menozzi, C., Raviele, A., Del Rosso, A., Dinelli, M., Solano, A., & Bottoni, N. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01241-4 · Cited by 444
CLINICAL GUIDELINE: Diagnosing Syncope: Part 2: Unexplained Syncope
Linzer, M., Yang, E. H., Estes, N. A. M., Wang, P., Vorperian, V. R., & Kapoor, W. N. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-1-199707010-00014 · Cited by 313
Patients With Syncope Admitted to Medical Intensive Care Units
Silverstein, M. D. (1982) · JAMA · doi:10.1001/jama.1982.03330100023024 · Cited by 251
Raviele, A., Menozzi, C., Brignole, M., Gasparini, G., Alboni, P., Musso, G., Lolli, G., Oddone, D., Dinelli, M., & Mureddu, R. (1995) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)80079-4 · Cited by 249
Prospective evaluation of syncope
Martin, G. J., Adams, S. L., Martin, H. G., Mathews, J., Zull, D., & Scanlon, P. J. (1984) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(84)80511-9 · Cited by 239
McIntosh, S. J., Lawson, J., & Kenny, R. A. (1993) · The American Journal of Medicine · doi:10.1016/0002-9343(93)90261-m · Cited by 238
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Research works printed but not linked: 2
- ANMCO Task Force. ANMCO Task Force Report: Orientamenti sulla valutazione diagnostica dei pazienti con sincope. G Ital Cardiol 1995; 25: 937-48.
- Linzer M, Yang E, Estes M, Wang P, Vorperian V, Kapoor W. Diagnosing syncope. Part II: Unexplained syncope. Ann Intern Med 1997; 127: 76-86.
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Items 101–104 of 104
Diagnostic orientation and risk stratification in syncope
Buzea, A., Dan, A. R., & Dan, G. A. (2013) · Romanian Journal of Neurology · doi:10.37897/rjn.2013.3.1
Pascual, J. F., & Estrada, N. L.-T. (2024) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2023.12.016
Almeida, C., Oliveira, M., Laranjo, S. M., & Perelman, J. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-14945-w
Diagnostic performance of artificial intelligence in the syncope unit
van Zanten, S., Boel, T. T., de Jong, J. S. Y., Koomen, E. M., Bais, B., Dara, A., Giele, F., Geertsma, C., Sutton, R., Scheffer, M. G., et al. (2026) · Exploration of Cardiology · doi:10.37349/ec.2026.1012114
Metadata
- Authors
- Croci, F.
- Affiliations
- Presidio Ospedaliero (IT)
- Corresponding author
- Croci, F
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-10
- Volume
- 4
- Issue
- 4
- Pages
- 351-355
- ISSN
- 1099-5129 (ISSN-L)
- OpenAlex
- W2170822387
- Cited by
- 105
- References
- 19
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 18 · 2016: 4 · 2015: 5 · 2014: 7 · 2013: 10 · 2012: 3
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- syncope, diagnostic workup, syncope unit, diagnostic yield, tilt table test, carotid sinus massage, electrophysiological study, exercise testing, neurally mediated syncope, unexplained syncope
- MeSH terms
- Adult, Aged, Aged, 80 and over, Algorithms, Female, Humans, Male, Middle Aged, Physical Examination, Syncope, Electrocardiography, Ambulatory, Practice Guidelines as Topic
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