Brain Computed Tomography evaluation of patients with syncopal episode in the emergency department at King Hussein Medical Center
Abstract
Objective: The aim of our study is to determine the value of using brain computerized tomography as a routine investigation in patients presenting with syncope to the emergency department at King Hussein Medical Center Amman Jordon.
Methods: In the time period between March 2006 and April 2008, a total of 254 patients (134 males and 120 females) with a mean age ± SD of 62 ±27 years (range: 32-73) presented with syncope to the emergency department. All of these patients underwent various investigations to
verify the cause of syncope including brain CT scan. Patients were categorized into three groups according to CT scan findings and their neurological examination on presentation.
Results: Patients were classified into three groups based on their brain CT findings and their neurological examination on presentation.
The first group included 203 (79.9 %) patients, all of which had normal brain CT scan and normal neurological examination. The second group included 10 (3.9%) patients all of which had abnormal brain CT scan findings and abnormal neurological examination. The abnormal neurological findings can be attributed to their syncopal episode and abnormal brain CT findings. The third group included 41 (16.1%) patients who had abnormal brain CT findings and either normal or abnormal neurological examination which is not related and can’t be attributed to the
abnormal head CT findings and their syncopal episode.
Conclusion: The use of brain CT scan as a routine investigation in the evaluation of patients presented to the Emergency Department at king Hussein Medical Center with syncope is unjustifiable, unless these patients had abnormal neurological examination.
References
J Blanc, C L'her, G Gosselin et al. Prospective evaluation of an educational programme for physicians involved in the management of syncope Europace 2005; 7(4):400-406
Elesber AA, Decker WW, Smars PA et al. Impact of the Application of the American College of Emergency Physicians Recommendations for the Admission of Patients with Syncope on a Retrospectively Studied Population Presenting to the Emergency Department. Am Heart J 2005; 149(5):826-831.
Costantino G, Perego F, Dipaola F. Short- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission. J Am coll Cardiol 2008;51: 276-2833.
Crane D. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J 2002; 19:23-27
Oh JH, Hanusa BH, Kapoor WN et al. Do Symptoms Predict Cardiac Arrhythmias and Mortality in Patients with syncope? Arch Intern Med 1999; 159:375–80
Alboni P, Brignole M, Menozzi C et al. Diagnostic value of history in patients with syncope with or without heart disease Am.coll Cardiol, 2001; 37:1921- 196.
Goyal N, Donnino M, Vachhani R et al . The utility of head computed tomography in the emergency department evaluation of syncope. Intern Emerg Med 2006; 1 (2): 148-150.
Soteriades ES, Evans JC, Larson MG et al. Incidence and Prognosis of Syncope. The New England Journal of Medicine 2002; 347:878-885.
Pierre G, Edward M, Bednarczyk k et al. Syncope and head CT scans in the emergency department. Emerg Radiol 2005;12:44-46
Shen K, Wyatt W, Decker et al. Syncope Evaluation in the Emergency Department Study (SEEDS) A Multidisciplinary Approach to Syncope. Circulation. 2004; 110:3636-3645
Racco F, Sconocchini C, Reginelli R et al Syncope in a general population: etiologic, diagnosis and follow-up. Results of a prospective study. MinervaMed. 1993; 84(5):249-61.
Brignole M, Ungar A, Bartoletti A et al. Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals Europace 2006; 8(8):644-650 .
van Dijk N, Boer KR, Colman N et al High Diagnostic Yield and Accuracy of History, Physical Examination, and ECG in Patients with Transient Loss of Consciousness in FAST: The Fainting Assessment Study J Cardiovasc Electrophysiol. 2008; 19(1): 48-55.
Maxime L-Cliche .Syncope in Older Adults.Geriatrics Ageing. (2007); 10(4): 236-240.
Jhanjee R, van Dijk JG, Sakaguchi S et al. Syncope in Adults: Terminology, Classification, and Diagnostic Strategy . Pacing Clin Electrphysiol 2006; 29(2):1160-1169
Reed M J and Gray A. Collapse query cause: the management of adult syncope in the emergency department. Emerg Med J 2006; 23:589-594
Laurie Barclay. American College of Emergency Physicians Issues Guidelines for Treatment of Syncope. Ann Emerg Med 2007; 49:431-444
Kapoor W. Evaluation and outcome of patients with syncope. Medicine 1990; 69(3): 169-175.
