Stepwise evaluation of syncope: a prospective population-based controlled study.

Détails

ID Serval
serval:BIB_C108868F339D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Stepwise evaluation of syncope: a prospective population-based controlled study.
Périodique
International journal of cardiology
Auteur(s)
Sarasin F.P., Pruvot E., Louis-Simonet M., Hügli O.W., Sztajzel J.M., Schläpfer J., Herrera M., Graz J., Berchier C., Mischler C., Yersin B.
ISSN
1874-1754[electronic]
Statut éditorial
Publié
Date de publication
2008
Volume
127
Numéro
1
Pages
103-111
Langue
anglais
Notes
Publication types: Controlled Clinical Trial ; Journal Article - Publication Status: ppublish
Résumé
BACKGROUND: Evaluation of syncope remains often unstructured. The aim of the study was to assess the effectiveness of a standardized protocol designed to improve the diagnosis of syncope. METHODS: Consecutive patients with syncope presenting to the emergency departments of two primary and tertiary care hospitals over a period of 18 months underwent a two-phase evaluation including: 1) noninvasive assessment (phase I); and 2) specialized tests (phase II), if syncope remained unexplained after phase I. During phase II, the evaluation strategy was alternately left to physicians in charge of patients (control), or guided by a standardized protocol relying on cardiac status and frequency of events (intervention). The primary outcomes were the diagnostic yield of each phase, and the impact of the intervention (phase II) measured by multivariable analysis. RESULTS: Among 1725 patients with syncope, 1579 (92%) entered phase I which permitted to establish a diagnosis in 1061 (67%) of them, including mainly reflex causes and orthostatic hypotension. Five-hundred-eighteen patients (33%) were considered as having unexplained syncope and 363 (70%) entered phase II. A cause for syncope was found in 67 (38%) of 174 patients during intervention periods, compared to 18 (9%) of 189 during control (p<0.001). Compared to control periods, intervention permitted diagnosing more cardiac (8%, vs 3%, p=0.04) and reflex syncope (25% vs 6%, p<0.001), and increased the odds of identifying a cause for syncope by a factor of 4.5 (95% CI: 2.6-8.7, p<0.001). Overall, adding the diagnostic yield obtained during phase I and phase II (intervention periods) permitted establishing the cause of syncope in 76% of patients. CONCLUSION: Application of a standardized diagnostic protocol in patients with syncope improved the likelihood of identifying a cause for this symptom. Future trials should assess the efficacy of diagnosis-specific therapy.
Mots-clé
Aged, Chi-Square Distribution, Comorbidity, Diagnosis, Differential, Female, Humans, Intervention Studies, Logistic Models, Male, Middle Aged, Population Surveillance, Prospective Studies, Syncope, Treatment Outcome
Pubmed
Web of science
Création de la notice
29/01/2008 9:42
Dernière modification de la notice
03/03/2018 21:07
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