Syncope of unknown origin. The need for a more cost-effective approach to its diagnosis evaluation

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Abstract
The records of 121 patients hospitalized in Presbyterian-University Hospital, Pittsburgh, [USA], during 1976 to 1980 for syncope of unknown origin were reviewed. There were 58 men and 63 women, whose mean age was 63.1 yr. Cardiac monitoring in 67 patients showed abnormalities in 7 patients, considered diagnostic of the cause of syncope. In 13 patients with electrophysiologic studies, 4 patients had abnormal results, suggesting a probable cause for the syncope. Cardiac catheterization in 14 patients showed significant findings that demonstrated the cause of syncope in 3 patients. Glucose tolerance tests in 37 patients, head computed tomographic scans in 39 patients, radionuclide brain scans in 15 patients, lumbar punctures in 22 patients, and skull roentgenograms in 46 patients did not aid in the diagnosis of the cause of syncope in any patient. In 67 patients, EEG produced abnormal results in 26, but the role of EEG in the diagnostic workup of syncope could not be completely defined. The definitive cause for syncope was diagnosed in only 13 of 121 patients, with an average hospitalization of 9 days. An extensive evaluation of syncope is cost-ineffective, and prospective goal-directed approaches need to be developed.

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