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Many Syncopal Episode Tests Deemed Unnecessary

Study suggests priority should be given to less expensive, higher-yield tests

TUESDAY, July 28 (HealthDay News) -- Older patients are often given unnecessary tests to evaluate syncopal episodes, and more attention should be paid to patient history and examination, according to a study in the July 27 issue of the Archives of Internal Medicine.

Mallika L. Mendu, M.D., and colleagues at the Yale University School of Medicine in New Haven, Conn., conducted a review of 2,106 patients aged 65 years and above who were admitted to the hospital after a syncopal episode. The researchers assessed which tests were most commonly performed and calculated the utility and cost of tests.

The researchers found that, in all, 99 percent of patients were given an electrocardiogram, 95 percent underwent telemetry, 95 percent had cardiac enzyme tests and 63 percent had a computed tomography head scan. However, echocardiography, cardiac enzyme tests, computed tomography scans, carotid ultrasonography and electroencephalography only helped to diagnose or manage less than 5 percent of cases, while helping only to determine the etiology of syncope in less than 2 percent of cases. The authors further note that postural blood pressure recording was performed in only 38 percent of cases, but it had the highest yield with regard to affecting diagnosis (18 to 26 percent), management (25 to 30 percent), and determination of etiology (15 to 21 percent).

"Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope," Mendu and colleagues conclude.

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