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. 2020 Dec 23;22(12):1896-1903.
doi: 10.1093/europace/euaa246.

Frequency of injuries associated with syncope in the prevention of syncope trials

Juliana G Jorge  1 , Payam Pournazari  1 , Satish R Raj  1 , Connor Maxey  1 , Robert S Sheldon  1
Affiliations

Frequency of injuries associated with syncope in the prevention of syncope trials

Juliana G Jorge et al. Europace. .

Abstract

Aims: Syncope can lead to injuries. We determined the frequency, severity, and predictors of injuries due to syncope in cohorts of syncope patients.

Methods and results: Participants were enrolled in the POST2 (fludrocortisone) and POST4 (midodrine) vasovagal syncope (VVS) randomized trials, and POST3 enrolled patients with bifascicular block and syncope. Injury was defined as minor (bruising, abrasions), moderate (lacerations), and severe (fractures, burns, joint pain), and recorded up to 1 year after enrolment. A total of 459 patients (median 39 years) were analysed. There were 710 faints occurred in 186 patients during a 1-year follow-up. Fully 56/186 (30%) of patients were injured with syncope (12% of overall group). There were 102 injuries associated with the 710 faints (14%), of which 19% were moderate or severe injuries. Neither patient age, sex, nor the presence of prodromal symptoms associated with injury-free survival. Patients with bifascicular block were more prone to injury (relative risk 1.98, P = 0.018). Patients with ≥4 faints in the prior year had more injuries than those with fewer faints (relative risk 2.97, P < 0.0001), but this was due to more frequent syncope, and not more injuries per faint. In VVS patients, pharmacological therapy significantly reduced the likelihood of an injury due to a syncopal spell (relative risk 0.64, P = 0.015). Injury severity did not associate with age, sex, or prior-year syncope frequency.

Conclusion: Injuries are frequent in syncope patients, but only 4% of injuries were severe. None of age, sex, and prodromal symptoms associate with injury.

Keywords: Clinical trial; Injury; Injury severity; Syncope; Vasovagal.

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Figures

Figure 1
Figure 1
Survival free of events in follow-up. Top panel, comparison of syncope and injury rates in the total population. Middle panel, comparison of survival free of injury in males and females. Bottom panel, comparison of survival free of injury in patients with more or fewer than the median numbers of faints in the year before study enrolment. The median number of faints in the year before randomization was 3.
Figure 2
Figure 2
Distribution of minor, moderate, and severe injuries associated with syncopal spells.
See this image and copyright information in PMC

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