© 2003 by European Society of Cardiology
Management of patients with syncope referred urgently to general hospitals
1Department of Cardiology, Ospedale S Chiara Trento, Italy; 2Department of Cardiology, Ospedale del Tigullio Lavagna, Italy; 3Department of Cardiology, Ospedale S Maria Nuova Reggio Emilia, Italy; 4Department of Cardiology, Ospedale Umberto I Mestre, Italy; 5Department of Cardiology, Ospedale Policlinico Universitario Bari, Italy; 6Department of Cardiology, Ospedale S Filippo Rome, Italy; 7Department of Cardiology, Ospedale S Maria della Misericordia Udine, Italy; 8Department of Cardiology, Ospedale Riuniti Bergamo, Italy; 9Medtronic Italia SpA Milan, Italy
OBJECTIVE: To evaluate the incidence and the strategy of management of syncope admitted urgently to a general hospital.
BACKGROUND: The management of patients with syncope is not standardized.
METHODS: The study was a prospective observational registry from a sample of 28 general hospitals in Italy and enroled all consecutive patients referred to their emergency rooms from November 5th 2001 to December 7th 2001 who were affected by transient loss of consciousness as the principal symptom.
RESULTS: The incidence of syncope was 0.95% (996 of 105,173 patients attending). Forty-six percent were hospitalized, mostly in the Department of Internal Medicine. The mean in-hospital stay was 8.1±5.9 days. A mean of 3.48 tests was performed per patient. A definite diagnosis was made in 80% of cases, neurally-mediated syncope being the most frequent. The findings of each of the 28 hospitals participating in the survey were separately evaluated. We observed great inter-hospital and inter-department heterogeneity regarding the incidence of emergency admission, in-hospital pathways, most of the examinations performed and the final assigned diagnosis. For example, the execution of carotid sinus massage ranged from 0% in one hospital to 58% in another (median 12.5%); tilt testing ranged from 0 to 50% (median 5.8%); the final diagnosis of neurally-mediated syncope ranged from 10 to 78.6% (median 43.3%).
CONCLUSION: Great inter-hospital and inter-department heterogeneity in the incidence and management of syncope was observed in general hospitals. As a consequence, we were unable to describe a uniform strategy for the management of syncope in everyday practice.
Key Words: Syncope, diagnosis, emergency medicine
Correspondence: Michele Brignole, MD FESC, Department of Cardiology and Arrhythmologic Centre, Ospedale del Tigullio, Via don Bobbio, Lavagna 16033, Italy. Tel.: +39-0185-329569; fax: +39-0185-306506; E-mail: mbrignole{at}asl4.liguria.it
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