Expensive Tests to Evaluate Syncope Don't Yield as Much as Simple Postural BP

In evaluating syncope in older patients, simpler less-expensive tests are more likely to affect diagnosis and treatment, according to an Archives of Internal Medicine study.

Researchers examined medical records in some 2100 consecutive admissions of patients aged 65 or older presenting to an emergency room with syncope. The researchers determined which tests affected diagnosis or management, and they calculated the costs incurred for each management-changing test result.

Postural blood pressure measurement had the highest yield, but was performed in only about a third of cases. Its use incurred about $20 in cost for each positive result. Other, more frequently performed tests, like EEGs ($33,000), head CT scans ($25,000), and cardiac enzymes ($22,000), were much less efficient in yielding useful information. Postural BP measurements affected management or diagnosis about 25% of the time, whereas some of the more expensive tests affected practice in less than 5% of cases.