© 2003 by European Society of Cardiology
Management of syncope referred urgently to general hospitals with and without syncope units
1Department of Cardiology, Ospedale del Tigullio Lavagna, Italy; 2Department of Cardiology, Ospedale S Chiara Trento, Italy; 3Department of Cardiology, Ospedale S Maria Nuova Reggio Emilia, Italy; 4Department of Cardiology, Ospedale Umberto I Mestre, Italy; 5Department of Cardiology, Ospedale Civile Cento, Italy; 6Department of Cardiology, Ospedale Policlinico Universitario Bari, Italy; 7Department of Cardiology, Ospedale S Maria dei Battuti Conegliano Veneto, Italy; 8Department of Cardiology, Ospedale Policlinico Universitario Modena, Italy; 9Department of Cardiology, Ospedale Niguarda Milan, Italy; 10Medtronic Italia SpA Milan, Italy
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.
Key Words: Syncope, diagnosis, emergency medicine, syncope unit
Correspondence: M. Brignole, Department of Cardiology and Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio, 16033 Lavagna, Italy. Tel.: +39-0185-329569; Fax: +39-0185-306506; E-mail: mbrignole{at}asl4.liguria.it
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