Routine or protocol evaluation of trauma patients with suspected syncope is unnecessary

J Trauma. 2011 Feb;70(2):428-32. doi: 10.1097/TA.0b013e31820958be.


Background: Syncope is a commonly suspected cause of injury. Patients often undergo extensive testing without proven benefit. In this study, we investigated the utility of an inpatient syncope workup.

Methods: A retrospective review was performed of all admissions to a Level I trauma center after fall or motor vehicle collision in patients older than 50 years and in whom syncope was suspected for the 3-year period ending December 2008. Demographics, diagnostic workup, number of abnormal results, and the frequency of subsequent interventions were recorded.

Results: Two thousand one hundred seventy-one patients fulfilled study entry criteria; syncope was suspected in 302. The syncope and nonsyncope groups, respectively, were similar in age (76.9 years±12 years vs. 74.8 years±13 years) and female gender (58.3% vs. 58.4%) but differed in Injury Severity Score (7.4±5.7 vs. 9.7±7.7; p<0.01). Diagnostic workup commonly included electrocardiogram (89.4%), cardiac enzymes (88.7%), echocardiogram (78.8%), and carotid duplex or computed tomography angiography (64.9%). Significant abnormal results were uncommon: cardiac enzymes (2.9%), echocardiogram (3.8%), and carotid imaging (4.6%). Overall only 42 patients (13.9%) required further intervention, and in 29 patients (69%), the intervention was based on the initial history, physical examination, or admitting electrocardiogram.

Conclusion: Routine inpatient syncope workup has a low yield. Our data suggests that the diagnostic workup should be ordered based on clinical information rather than a standardized workup for all patients with suspected syncope.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carotid Arteries / diagnostic imaging
  • Clinical Protocols
  • Diagnostic Tests, Routine
  • Electrocardiography
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Radiography
  • Regression Analysis
  • Retrospective Studies
  • Syncope / complications
  • Syncope / diagnosis*
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / etiology*