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J Hosp Med. 2017 Dec;12(12):984-988. doi: 10.12788/jhm.2864. Epub 2017 Oct 18.

Things We Do For No Reason: Echocardiogram in Unselected Patients with Syncope.

Author information

1
New York University School of Medicine, Division of General Internal Medicine, Veterans Affairs NY Harbor Healthcare System, Manhattan Campus, New York, New York, USA.
2
University of North Carolina School of Medicine, Department of Internal Medicine, Division of Hospital Medicine, Chapel Hill, North Carolina, USA.
3
University of North Carolina School of Medicine, Department of Internal Medicine, Division of Hospital Medicine, Chapel Hill, North Carolina, USA. stephenj@med.unc.edu.

Abstract

Syncope is a common cause of emergency department visits and hospitalizations. Echocardiogram is frequently used as a diagnostic tool in the evaluation of syncope, performed in 39% to 91% of patients. The diagnostic yield of echocardiogram for detecting clinically important abnormalities in patients with a normal history, physical examination, and electrocardiogram (ECG), however, is extremely low. In contrast, echocardiograms performed on patients with syncope with a positive cardiac history, abnormal examination, and/or ECG identify an abnormality in up to 29% of cases, though these abnormalities are not always defi nitively the cause of symptoms. Recently updated clinical guidelines for syncope management from the American College of Cardiology now recommend echocardiogram only if initial history or examination suggests a cardiac etiology, or ECG is abnormal. Universal echocardiography in patients with syncope exposes a signifi cant number of patients to unnecessary testing and cost and does not represent evidence-based or high-value patient care.

PMID:
29073313
DOI:
10.12788/jhm.2864
[Indexed for MEDLINE]

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