Diagnostic approaches to syncope in Internal Medicine Departments and their effect on mortality

• Published in: European journal of internal medicine 2022-08, Vol.102, p.97-103
• Main Authors: Galron, Ehud, Kehat, Orli, Weiss-Meilik, Ahuva, Furlan, Raffaello, Jacob, Giris
• Format: Article
• Language: English
• Subjects: Diagnostic tests; Hospital; Internal medicine; Mortality; Syncope
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2022.05.015

•This is the first study to reveal differences in the approach to the diagnosis of patients admitted with syncope to Internal Medicine Departments and their effect on mortality.•Despite large variations in the number of diagnostic tests performed between departments, the mortality is not affected.•This is a further proof that a cost-effective personalized approach does not affect short term outcomes of patients hospitalized with syncope. Most data on mortality and investigational approaches to syncope comes from patients presented to emergency departments (ED). The aim of this study is to report intermediate term mortality in syncope patients admitted to Internal Medicine Departments and whether different diagnostic approaches to syncope affect mortality. Methods and results A single-center retrospective-observational study conducted at the Tel Aviv "Sourasky" Medical Center. Data was collected from electronic medical records (EMRs), from January 2010 to December 2020. We identified 24,021 patients, using ICD-9-CM codes. Only 7967 syncope patients were admitted to Internal Medicine Departments and evaluated. Logistic regression models were used to determine the effects of diagnostic testing per patient in each department on 30-day mortality and readmission rates. All-cause 30-day mortality rate was 4.1%. There was a significant difference in the number of diagnostic tests performed per patient between the different departments, without affecting 30-day mortality. The 30-day readmission rate was 11.4%, of which 4.4% were a result of syncope. Conclusion Syncope patients admitted to Internal Medicine Departments show a 30-day all-cause mortality rate of ∼4%. Despite the heterogeneity in the approach to the diagnosis of syncope, mortality is not affected. This novel information about syncope patients in large Internal Medicine Departments is further proof that the diagnosis of syncope requires a logic, personalized approach that focuses on medical history and a few tailored, diagnostic tests. [Display omitted]