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PE rare in patients with syncope

Giorgio Costantino

Pulmonary embolism was prevalent in less than 1% of patients presenting to the ED with syncope, according to research published in JAMA Internal Medicine.

“Syncope is a common symptom that occurs in one of four people during their lifetime,” Giorgio Costantino, MD, from Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda, Milan, Italy, and colleagues wrote. “PE has long been recognized as an important and serious cause of syncope. Data on its prevalence are scanty.”

Costantino and colleagues performed a retrospective, observational study to determine how prevalent PE is among patients who present to the ED with syncope. The researchers used longitudinal administrative data from five databases in four countries — the United States, Canada, Denmark and Italy — to identify patients aged 18 years or older who had syncope codes when discharged from the ED (n = 1,671,944).

Results showed that PE was identified in 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) of all patients and 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) of hospitalized patients. At 90 days of follow-up, there was a range in PE prevalence from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients.

Furthermore, venous thromboembolism was prevalent in 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) of all patients and 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) of hospitalized patients.

“Although evidence shows that not all patients with syncope should be screened for PE (this could cause more harms than benefit), we do not have data on what patients should be screened for it,” Costantino told Healio Internal Medicine. “As far as we know, we should suspect that PE might be the cause of syncope in either patients with risk factors for PE, such as presence of active neoplasm, bedridden and signs of deep vein thrombosis, or in those with specific signs or symptoms associated with syncope, such as dyspnea, chest pain and hemoptysis.

“Moreover, it could be useful to test if new simple algorithms, as the recently published YEARS algorithm, could be useful to reduce unnecessary tests in these patients,” he added. – by Alaina Tedesco

Disclosure: Constantino reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.