A prospective systematic evaluation using decision-making software and trained personnel achieved a diagnostic work-up consistent with ESC guidelines in 86% of syncope patients.
Observational (n=541)
Yes
Does a systematic guideline-based evaluation improve diagnostic yield in patients referred urgently for syncope?
Strict adherence to ESC guidelines using decision-making software and trained personnel achieves a definite diagnosis in 98% of patients presenting with syncope.
AIMS: 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.
Brignole et al. (2005) conducted an observational in Syncope (n=541). Guideline-based evaluation using decision-making software and trained personnel was evaluated on Completion of a diagnostic work-up consistent with the guidelines. A prospective systematic evaluation using decision-making software and trained personnel achieved a diagnostic work-up consistent with ESC guidelines in 86% of syncope patients.