Syncope workup typically necessitates hospitalization in higher risk patients, with significant costs, utilization of hospital resources and negative results in up to 30% of cases.
We recently established a one bed syncope unit (SU) at our Emergency Department (ED) for the purpose of fast track evaluation for intermediate risk (IR) syncope patients. We report here our initial experience.
Admission to SU was based on “risk stratification chart” including history, physical exam, blood tests, and ECG. Patients with one IR criterion (age > 65, abnormal ECG, known heart disease, exercise syncope, sudden onset, supine position, palpitations, trauma or occupational risk) were admitted to SU for up to 24 hours.
Over 8 months we had 1145 ER syncope admissions. 73 fulfilled the criteria and were admitted to the SU. Mean age was 48 years, 45% women, 14% diabetes, 34% hypertension, 16% known CAD, 8% previous MI, 18% known structural heart disease, 8% known arrhythmiа, 3% family history of SCD, and 30% had previous history of syncope. 97% of patients were in normal sinus rhythm with normal PR (150 ± 25msec) and QTc (424± 57 msec), 75.34% had normal QRS pattern.
Workup in all patients included: holter (8 hours at least), echo, orthostatic test. Carotid sinus massage was performed in 86.3%, Tilt test in 43.8%, ergometry in 9.6%, adenosine test in 2.7% and EPS in 4.1%. Seven patients were referred to have implantable loop recorder.
Workup was completed within 24 hours with diagnosis of reflex mediated syncope 76.71%, orthostatic hypotension in 6.8%; in 9.9% bradyarrhythmia was detected and pacemaker implantation was performed, in 1 case rapid atrial fibrillation was detected and medical treatment was started. Overall, a diagnosis was reached in 97.2%.
Conclusion: Using the ER SU Model we were able to reach high diagnostic yield within a short time period in IR patients.
