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lüll A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals Brignole M; Menozzi C; Bartoletti A; Giada F; Lagi A; Ungar A; Ponassi I; Mussi C; Maggi R; Re G; Furlan R; Rovelli G; Ponzi P; Scivales AEur Heart J 2006[Jan]; 27 (1): 76-82AIMS: The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting. METHODS AND RESULTS: Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9+/-1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%). CONCLUSION: The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope.|*Guideline Adherence[MESH]|*Practice Guidelines as Topic[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Emergencies[MESH]|Emergency Service, Hospital/statistics & numerical data[MESH]|Female[MESH]|Hospitalization/*statistics & numerical data[MESH]|Hospitals, General/*statistics & numerical data[MESH]|Humans[MESH]|Italy[MESH]|Male[MESH]|Middle Aged[MESH]|Prospective Studies[MESH]|Referral and Consultation/*statistics & numerical data[MESH]|Syncope/*therapy[MESH] |