Patients with syncope in a German emergency department: description of patients and processes

Abstract

Background: We studied the characteristics and resource utilization of patients with syncope in a German emergency department (ED).

Methods: We carried out a single-center retrospective analysis of patients with syncope who presented to the ED of the Klinikum Nürnberg (a municipal hospital in Nuremberg, Germany).

Results: Among the 28 477 patients who presented to the ED from 15 May 2009 to 30 September 2009, 440 (1.5%) presented with syncope. Their mean age was 62 years (standard deviation, 20 years); 50.4% were women, 43.4% were over age 70, 11.8% had cardiogenic and 4.8% neurological syncope, and 18.2% had more than two comorbid conditions. 20.7% were discharged after evaluation in the ED, 14.1% were brielfly hospitalized in the ED's clinical observation unit, and 56.6% were admitted to one of the hospital's specialty wards. 8.6% left the ED against medical advice. All of the syncope patients were evaluated by history-taking, physical examination, and 12-lead electrocardiogragraphy (ECG); ECG revealed abnormal findings in 36.4% of patients. Nearly all patients also underwent laboratory testing, which revealed hyponatremia (a serum sodium concentration under 130 mmol/L) in 5.9% and a serum creatinine level above 2 mg/dL in 5.3%. Many underwent technology-intensive tests such as cranial computed tomography (129 patients), but these tests only rarely yielded abnormal findings (3.1%). 27% of the syncope patients underwent Doppler ultrasonography of the vessels supplying the brain, with abnormal findings in 6.7% of cases. (Orthostatic testing was performed in 14.5% of the patients and was positive in 26.6%.)

Conclusion: Many patients presenting with syncope to a German ED are elderly, and multiple comorbidities are common. Technology-intensive testing in patients with syncope has a low diagnostic yield and consumes resources. The introduction of standards for the evaluation of syncope in the ED would be helpful.

Figure 1

Age-dependent distribution of patients with syncope

Figure 2

Instrumental examinations patient groups a) Frequency of instrumental examinations performed b) Percentage of pathological findings that were related to syncope by the performed tests

eFIGURE

Analysis of patients who presented to the Klinikum Nürnberg with syncope or near syncope as their main symptom during the study period. Medical records for 10 patients were incomplete or were not taken; these cases were excluded from the analysis