P. Laguna

Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study

AIMS To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). METHODS AND RESULTS A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%). ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient loss of consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P < 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. CONCLUSION Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.

3. Vasovagal Syncope, Tilt Testing

Clinical presentation of patients with syncope: implications for therapy. Objectives To asses the clinical presentation of syncope and its impact on acute management. Methods Prospective observational study in 19 ED during Dec, 2003. Results 1428 patients included (prevalence: 1,21%), age 57±22 y., 51% females. Co-morbidity hypertension 25%, structural HD 16% (CAD 62%), arrhythmia 11% (AF 67%, Pacemaker 17%, AV block 5%, SSS 3%, VT 2%), neurological disease (Stroke 67%, epilepsy 13%). Previous syncope 92%. Presentation: triggers in 52% (pain 9%, orthostatism 7%, crowded/warm places 6%, emotion 5%, drugs 5%, micturition 3%, exercise 3%, defaecation 1,5%, hemorrhage 0,8%, change in posture 0,6%) and prodromal symptoms in 60% (malaise/nausea/sweating 50%, palpitation 3%, chest pain 2,3%, dyspnoea 1,7%). Physical findings confusion 5%, ↓ level consciousness 0,4%, murmurs 4,3% heart failure 1,4%; BP and HR normal (95%). Disposition: discharge 73% (21% outpatient clinic: cardiology 6,7%), ED observation 10%, admission 16%. The presence of SHD was associated with admission and derivation to outpatient clinic (p<0.001). Conclusions Patients with syncope usually arrive without physical findings but clinical criteria are helpful to differentiate from non-syncopal attacks. Structural heart disease is the strongest clinical determinant of management.

3. Vasovagal Syncope, Tilt Testing3.1 Clinical Presentation of Patients with Syncope: Implications for Management

Clinical presentation of patients with syncope: implications for therapy. Objectives To asses the clinical presentation of syncope and its impact on acute management. Methods Prospective observational study in 19 ED during Dec, 2003. Results 1428 patients included (prevalence: 1,21%), age 57±22 y., 51% females. Co-morbidity hypertension 25%, structural HD 16% (CAD 62%), arrhythmia 11% (AF 67%, Pacemaker 17%, AV block 5%, SSS 3%, VT 2%), neurological disease (Stroke 67%, epilepsy 13%). Previous syncope 92%. Presentation: triggers in 52% (pain 9%, orthostatism 7%, crowded/warm places 6%, emotion 5%, drugs 5%, micturition 3%, exercise 3%, defaecation 1,5%, hemorrhage 0,8%, change in posture 0,6%) and prodromal symptoms in 60% (malaise/nausea/sweating 50%, palpitation 3%, chest pain 2,3%, dyspnoea 1,7%). Physical findings confusion 5%, ↓ level consciousness 0,4%, murmurs 4,3% heart failure 1,4%; BP and HR normal (95%). Disposition: discharge 73% (21% outpatient clinic: cardiology 6,7%), ED observation 10%, admission 16%. The presence of SHD was associated with admission and derivation to outpatient clinic (p<0.001). Conclusions Patients with syncope usually arrive without physical findings but clinical criteria are helpful to differentiate from non-syncopal attacks. Structural heart disease is the strongest clinical determinant of management.

Clinical Presentation of Patients with Syncope: Implications for Management

Clinical presentation of patients with syncope: implications for therapy. Objectives To asses the clinical presentation of syncope and its impact on acute management. Methods Prospective observational study in 19 ED during Dec, 2003. Results 1428 patients included (prevalence: 1,21%), age 57±22 y., 51% females. Co-morbidity hypertension 25%, structural HD 16% (CAD 62%), arrhythmia 11% (AF 67%, Pacemaker 17%, AV block 5%, SSS 3%, VT 2%), neurological disease (Stroke 67%, epilepsy 13%). Previous syncope 92%. Presentation: triggers in 52% (pain 9%, orthostatism 7%, crowded/warm places 6%, emotion 5%, drugs 5%, micturition 3%, exercise 3%, defaecation 1,5%, hemorrhage 0,8%, change in posture 0,6%) and prodromal symptoms in 60% (malaise/nausea/sweating 50%, palpitation 3%, chest pain 2,3%, dyspnoea 1,7%). Physical findings confusion 5%, ↓ level consciousness 0,4%, murmurs 4,3% heart failure 1,4%; BP and HR normal (95%). Disposition: discharge 73% (21% outpatient clinic: cardiology 6,7%), ED observation 10%, admission 16%. The presence of SHD was associated with admission and derivation to outpatient clinic (p<0.001). Conclusions Patients with syncope usually arrive without physical findings but clinical criteria are helpful to differentiate from non-syncopal attacks. Structural heart disease is the strongest clinical determinant of management.

4. Syncope Evaluation & Syncope Unit

Background Previous studies suggest that the management of patients (pts) with syncope admitted to the emergency room (ER) is not standardized. Aims To perform a review of all ER visits in a period of three months, searching for syncope (Sync) and presyncope (Presync) consults, determining incidence, admission rates and diagnostic yield of pts admitted to the ER. Methods Systematic review of electronic charts from 4 academic hospitals. Admission and discharge diagnosis were recorded. A simple standardized diagnostic algorithm based on clinical presentation, previous history, physical examination and ancillary diagnostic tests were blindly reviewed by 3 of the investigators and compared with the admission and discharge diagnosis. Results Sync/presync was the primary diagnosis in 438: Sync 318 (72%) and Presync 120 (28%). Mean age of pts with Sync and Presync was 56±23.5 years, and 50% were females. Structural heart disease was present in 20% (CAD 69%). 123 pts (28%) with Sync/Presync were admitted, representing 0.51% of all ER. Average length of stay was 7.4±9.8 days. Average estimated cost in admitted pts was CAN

4. Syncope Evaluation & Syncope Unit4.1 ECG Performance and Interpretation in Patients Admitted to an Emergency Department because of Loss of Consciousness

4570.33±4700. Diagnosis at the ER visit, discharge and RESASTER diagnosis are summarized in the table: ![Graphic][1] Conclusions Application of a retrospective algorithmic diagnostic approach applied during ER assessment of pts with sync/presync increased diagnostic yield (15% to 77%), with vasovagal syncope accounting for more than half of the diagnosis. Simple clinical may reduce unnecessary testing, costs and hospital admissions in pts presenting with syncope to the ER. [1]: /embed/graphic-1.gif

ECG Performance and Interpretation in Patients Admitted to an Emergency Department because of Loss of Consciousness

Background Previous studies suggest that the management of patients (pts) with syncope admitted to the emergency room (ER) is not standardized. Aims To perform a review of all ER visits in a period of three months, searching for syncope (Sync) and presyncope (Presync) consults, determining incidence, admission rates and diagnostic yield of pts admitted to the ER. Methods Systematic review of electronic charts from 4 academic hospitals. Admission and discharge diagnosis were recorded. A simple standardized diagnostic algorithm based on clinical presentation, previous history, physical examination and ancillary diagnostic tests were blindly reviewed by 3 of the investigators and compared with the admission and discharge diagnosis. Results Sync/presync was the primary diagnosis in 438: Sync 318 (72%) and Presync 120 (28%). Mean age of pts with Sync and Presync was 56±23.5 years, and 50% were females. Structural heart disease was present in 20% (CAD 69%). 123 pts (28%) with Sync/Presync were admitted, representing 0.51% of all ER. Average length of stay was 7.4±9.8 days. Average estimated cost in admitted pts was CAN

Analysis of Current Management of Atrial Fibrillation in the Acute Setting: GEFAUR-1 Study

4570.33±4700. Diagnosis at the ER visit, discharge and RESASTER diagnosis are summarized in the table: ![Graphic][1] Conclusions Application of a retrospective algorithmic diagnostic approach applied during ER assessment of pts with sync/presync increased diagnostic yield (15% to 77%), with vasovagal syncope accounting for more than half of the diagnosis. Simple clinical may reduce unnecessary testing, costs and hospital admissions in pts presenting with syncope to the ER. [1]: /embed/graphic-1.gif

Risk factors for stroke and thromboprophylaxis in atrial fibrillation: what happens in daily clinical practice? The GEFAUR-1 study ☆ ☆☆ ★ ★★ ☆☆☆

Background Previous studies suggest that the management of patients (pts) with syncope admitted to the emergency room (ER) is not standardized. Aims To perform a review of all ER visits in a period of three months, searching for syncope (Sync) and presyncope (Presync) consults, determining incidence, admission rates and diagnostic yield of pts admitted to the ER. Methods Systematic review of electronic charts from 4 academic hospitals. Admission and discharge diagnosis were recorded. A simple standardized diagnostic algorithm based on clinical presentation, previous history, physical examination and ancillary diagnostic tests were blindly reviewed by 3 of the investigators and compared with the admission and discharge diagnosis. Results Sync/presync was the primary diagnosis in 438: Sync 318 (72%) and Presync 120 (28%). Mean age of pts with Sync and Presync was 56±23.5 years, and 50% were females. Structural heart disease was present in 20% (CAD 69%). 123 pts (28%) with Sync/Presync were admitted, representing 0.51% of all ER. Average length of stay was 7.4±9.8 days. Average estimated cost in admitted pts was CAN

Documento de consenso sobre el tratamiento de la fibrilación auricular en los servicios de urgencias hospitalarios

4570.33±4700. Diagnosis at the ER visit, discharge and RESASTER diagnosis are summarized in the table: ![Graphic][1] Conclusions Application of a retrospective algorithmic diagnostic approach applied during ER assessment of pts with sync/presync increased diagnostic yield (15% to 77%), with vasovagal syncope accounting for more than half of the diagnosis. Simple clinical may reduce unnecessary testing, costs and hospital admissions in pts presenting with syncope to the ER. [1]: /embed/graphic-1.gif