Syncope-related trauma: Rationale and yield of diagnostic studies

Background: Syncope occasionally occurs in trauma patients. The most appropriate and cost-effective evaluation for such patients is unknown, Methods: Trauma patients admitted to a Level I trauma center with a diagnosis of syncope or possible syncope between 1988 and 1994 were reviewed. History, physical examination, and past medical history were noted, as were the results of tests done as part of the syncope evaluation. Results: Eighty-eight patients were reviewed; 45% had been injured in falls. Thirteen patients who remembered their entire injury and denied syncope as a cause had negative evaluations. History, physical examination, and admission laboratory values were helpful in diagnosis 59% of the time. Subsequent evaluation provided useful diagnostic information 30% of the time, No patients with normal admission electrocardiograms (EKGs) had cardiac causes for their syncope, Conclusions: (1) Patients with possible syncope without loss of consciousness require no further evaluation, (2) A cerebrovascular evaluation should be the initial diagnostic approach in patients with signs and symptoms suggestive of stroke or transient ischemic attack, (3) Possible syncope patients with normal admission EKGs should undergo computed tomography of the head and electroencephalography, Those with abnormal EKGs should undergo echocardiography.