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JAMA Intern Med. 2018 Mar 1;178(3):356-362. doi: 10.1001/jamainternmed.2017.8175.

Prevalence of Pulmonary Embolism in Patients With Syncope.

Author information

Dipartimento di Medicina Interna, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Hellerup, Denmark.
Department of Emergency Medicine, Stanford University, Stanford, California.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
Danish Heart Foundation, Copenhagen, Denmark.
The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Department of Medicine, University of Alberta, Edmonton, Canada.
Epidemiology Unit, Agency for Health Protection of the Province of Milan, Milan, Italy.
Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland.
Dipartimento di Scienze Biomediche e Cliniche "L. Sacco," Università degli Studi di Milano, Milan, Italy.



Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope.


To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope.

Design, Setting, and Participants:

This retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged ≥18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016.

Main Outcomes and Measures:

The prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed.


A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged 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. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients.

Conclusions and Relevance:

Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.

[Available on 2019-01-29]

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