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Differential diagnosis
A standardised sequential clinical examination identified probable causes of syncope in 69% of patients

https://doi.org/10.1136/ebm.7.2.64

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    (2001) Am J Med 111, 177. Sarasin FP, Louis-Simonet M, Carballo D. , et al. . Prospective evaluation of patients with syncope: a population-based study.. Aug 15;. :. –84.
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 QUESTION: What are the causes of syncope in patients presenting to the emergency department (ED)?

    Design

    18 month cohort study.

    Setting

    The ED and inpatient services of a major primary and tertiary care hospital in Geneva, Switzerland.

    Patients

    788 consecutive patients ≥ 18 years of age who presented to the ED with a chief symptom of syncope. Patients with symptoms clearly compatible with seizure disorders, vertigo, dizziness, coma, or shock were excluded. 650 patients (82%) were included in the analysis (mean age 60 y, 52% women).

    Diagnostic strategy

    All patients had a standardised evaluation that included a complete history, physical, and neurological examination; laboratory examination (haematocrit and serum concentrations of creatine kinase and glucose); 12 lead electrocardiogram (ECG); testing for orthostatic hypotension; and bilateral carotid massage in patients …

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    Footnotes

    • Source of funding: Swiss National Research Foundation.

    • For correspondence: Dr F P Sarasin, Hôpital Cantonal, Geneva, Switzerland. francois.sarasin{at}hcuge.ch.