Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study
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AIMS: To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). METHODS AND RESULTS: A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%). ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient loss of consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P < 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. CONCLUSION: Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.
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More often extended monitoring is necessary because at the time of evaluation the cause of syncope remains elusive due to its transient and intermittent nature.
“however, more often extended monitoring is necessary as at the time of the evaluation the cause of syncope remains elusive because of its transient and intermittent nature (Baron-Esquivias et al., 2010).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Baron-Esquivias et al., 2010
The “Final diagnosis at the ED” section (page not available) reports that the cause of syncope was unexplained in 28.5% of patients, supporting the point that evaluation can leave its cause undetermined. The paper does not say that extended monitoring is often necessary or attribute the diagnostic difficulty to syncope’s intermittent nature. (LLM, conf=0.83)
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- Authors
- Baron-Esquivias, G., Martinez-Alday, J., Martin, A., Moya, A., Garcia-Civera, R., Paz Lopez-Chicharro, M., Martin-Mendez, M., del Arco, C., & Laguna, P.
- Affiliations
- Hospital de Basurto (ES)
- Hospital Universitario Severo Ochoa (ES)
- Hospital Clínico Universitario de Valencia (ES)
- Medtronic (Spain) (ES)
- Hospital Universitario Puerta de Hierro Majadahonda (ES)
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-03-09
- Volume
- 12
- Issue
- 6
- Pages
- 869-876
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W174504920
- Cited by
- 8
- References
- 22
- Citations by year
- 2024: 1 · 2021: 1 · 2020: 1 · 2018: 1 · 2015: 1 · 2014: 1 · 2013: 2
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sociedad Española de Cardiología
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- syncope, transient loss of consciousness, emergency department, diagnostic yield, electrocardiogram, orthostatic test, chest radiography, clinical guideline adherence, diagnostic accuracy, hospitalization
- MeSH terms
- Adult, Aged, Aged, 80 and over, Electrocardiography, Emergency Medical Services, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Spain, Unconsciousness, Incidence, Prevalence, Practice Guidelines as Topic, Age Distribution, Sex Distribution, Guideline Adherence
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