Testing for the Cause of Syncope in Elders

Researchers evaluated the frequency of use, yield, and costs of diagnostic tests for syncope and whether use of the San Francisco Syncope Rule improves test yield in a retrospective chart review of 1920 patients aged 65 and older (mean age, 79). Patients received admission or discharge diagnoses of syncope at a single U.S. acute care hospital from 2002 through 2006.

Electrocardiogram was the most frequently ordered test (99% of admissions); however, only 21% of ECGs were abnormal, 7% affected the diagnosis, and 3% aided in determining the etiology of the syncope episode. Cardiac enzyme levels (95% of admissions) were abnormal (elevated troponin) in only 5%. Echocardiogram (39% of admissions) had the highest frequency of abnormal results (63%…