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Cited by 109Cardiovascular Syncope and Autonomic DisordersVestibular and auditory disordersClinical Reasoning and Diagnostic Skills

Does the use of a syncope diagnostic protocol improve the investigation and management of syncope?

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Farwell, D J, Sulke, A N·2004·Heart
DOI 10.1136/heart.90.1.52PMC PMC1768011
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Abstract

Objectives: To assess the efficacy of a protocol designed to improve the diagnosis and management of syncope. Design: Prospective outcome analysis of all patients presenting with syncope for the 12 month period from 1 November 2000 to 31 October 2001, compared with a retrospective study of all patients presenting with syncope during the calendar year 1998. Use of the protocol commenced in September 2000. Setting: Eastbourne District General Hospital, serving a population of approximately 250 000; 25% are older than 65 years. Subjects: 421 consecutive patients presenting with syncope, investigated prospectively in January 2000 and compared with 660 patients retrospectively analysed for the calendar year 1998. Results: In 1998, 71% of patients with syncope received a diagnostic classification. In January 2000 there was an appropriate diagnostic hypothesis for every patient. Ultimately a diagnosis was made for 78% of patients according to accepted criteria (p = 0.003). Use of tests with the highest diagnostic effectiveness, such as tilt tests, increased in 2001 and many tests were used more appropriately (such as echocardiography). However, non-diagnostic tests were still frequently used (such as chest radiography, electroencephalography, and carotid Doppler studies). Costs of investigation and hospital stay rose from £611 to £1384 (€874 to €1980) per patient (p < 0.001), with cost per diagnosis increasing from £870 (€1245) in 1998 to £1949 (€2790) (p < 0.001). Conclusion: The syncope protocol improved diagnosis and the use of appropriate investigations. However, significant inappropriate investigation and hospital admission still occurred. The protocol allowed reliable triage of syncopal patients into high and low risk groups.

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  • The incidence of severe trauma was high in PICTURE compared with other reports, particularly considering that the first syncope occurred only a few years before the implant.

    “In comparison with these and other reports,15 the incidence of severe trauma was high in PICTURE, particularly considering that the first syncope occurred only a few years before the implant.”

    From Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry (2011) · cites this paper as [15]

  • Single-center studies from multiple countries, including Austria, the United Kingdom, Israel, and Spain, confirm similarly high costs associated with the hospital evaluation of syncope.

    “Single-center studies from multiple countries, including Austria, the United Kingdom, Israel, and Spain, confirm similarly high costs associated with the hospital evaluation of syncope (122,737,738).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [737]

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Authors
Farwell, D. J., & Sulke, A. N.
Affiliations
Eastbourne District General Hospital (GB)
Corresponding author
Sulke, A N
Venue
Heart
Publisher
BMJ
Published
2003-12-15
Volume
90
Issue
1
Pages
52-58
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
DOI
10.1136/heart.90.1.52
PMC
PMC1768011
OpenAlex
W2013795906
Cited by
109
References
35
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 10 · 2016: 1 · 2015: 3 · 2014: 7 · 2013: 8 · 2012: 7
FWCI
4.47
Type
journal article
Language
en
Open access
Locations
  • Heart (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
syncope, diagnostic protocol, syncope diagnosis, diagnostic workup, tilt table test, echocardiography, hospital costs, risk stratification, syncope management
MeSH terms
Aged, Clinical Protocols, Echocardiography, England, Hospitals, District, Humans, Length of Stay, Prospective Studies, Retrospective Studies, Sensitivity and Specificity, Syncope, Electrocardiography, Ambulatory, Hospital Costs, Tilt-Table Test

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