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Hospital Medicine 2014: Improving Syncope Evaluation in the ED

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The Particulars: Data indicate that evaluation and risk stratification of syncope often does not follow evidence-based guidance. This is occurring despite syncope being a challenging and costly condition. An evaluation algorithm that uses a patient’s history, physical examinations, and simple tests (eg, orthostatic vital signs, electrocardiograms, and hemoglobin) may help clinicians adhere to practice guidelines for evaluating and managing syncope.

Data Breakdown: Researchers in California reviewed the charts of patients evaluated for syncope in the ED and analyzed them for adherence to evidence-based guidance. The team found that history data were important for risk stratification but were not obtained or documented for many patients. For example, orthostatic vital signs were only performed in 25% of patients. A substantial number of admissions and tests were performed outside the algorithmic guidance. Trained reviewers who used the algorithm had improvements in diagnostic accuracy.

Take Home Pearls: The evaluation and management of syncope in the ED appears to vary from best-practice protocols. Using an evaluation algorithm that utilizes a patient’s history, physical examinations, and simple tests appears to increase diagnostic accuracy.

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