Aims: The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting. Methods and results: Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally - to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9 ± 1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%). Conclusion The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope. © The European Society of Cardiology 2005. All rights reserved.

A new management of syncope: Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals / Brignole M.; Menozzi C.; Bartoletti A.; Giada F.; Lagi A.; Ungar A.; Ponassi I.; Mussi C.; Maggi R.; Re G.; Furlan R.; Rovelli G.; Ponzi P.; Scivales A.. - In: EUROPEAN HEART JOURNAL. - ISSN 0195-668X. - STAMPA. - 27:(2006), pp. 76-82. [10.1093/eurheartj/ehi647]

A new management of syncope: Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals

Giada F.;Ungar A.;Mussi C.;
2006

Abstract

Aims: The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting. Methods and results: Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally - to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9 ± 1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%). Conclusion The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope. © The European Society of Cardiology 2005. All rights reserved.
2006
27
76
82
Brignole M.; Menozzi C.; Bartoletti A.; Giada F.; Lagi A.; Ungar A.; Ponassi I.; Mussi C.; Maggi R.; Re G.; Furlan R.; Rovelli G.; Ponzi P.; Scivales A.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1190117
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