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Management of syncope referred urgently to general hospitals with and without syncope units Brignole M; Disertori M; Menozzi C; Raviele A; Alboni P; Pitzalis MV; Delise P; Puggioni E; Del Greco M; Malavasi V; Lunati M; Pepe M; Fabrizi DEuropace 2003[Jul]; 5 (3): 293-8OBJECTIVE: 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.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Emergency Service, Hospital/*statistics & numerical data[MESH]|Female[MESH]|Hospital Units/*statistics & numerical data[MESH]|Hospitals, General/*statistics & numerical data[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Practice Patterns, Physicians'/statistics & numerical data[MESH]|Referral and Consultation[MESH]|Registries[MESH]|Syncope/diagnosis/*therapy[MESH] |
