Prospective evaluation of an educational programme for physicians involved in the management of syncope.

AIM: Management of patients (pts) presenting syncope diverges markedly from the guidelines of the European Society of Cardiology (ESC). To improve this management, the easiest option seemed to be to educate physicians. The aim of the study was to evaluate the impact of an educational process on the use of unnecessary neurological investigations. METHODS AND RESULTS: Charts of pts presenting syncope during two 12-month periods (1999-2000 and 2002-2003) to the emergency department were systematically reviewed. Between the two periods, all physicians in charge of pts with syncope attended educational meetings. During these meetings recommendations of the ESC were presented with a special emphasis on the uselessness of neurological investigations. Four hundred and fifty-four pts (1.2%) presented to the emergency department for syncope during study period 1, and 524 (1.3%) during study period 2. Nineteen of the 169 pts (11%) directly discharged from the emergency department, had neurological investigations during study period 1 and 22 of the 279 (8%) during study period 2 (NS). In pts who were hospitalized, 48% had neurological investigations in groups 1 and 2. CONCLUSION: Education of physicians in charge of patients with syncope is inadequate to improve the cost effectiveness of the management of these patients.

Prospective evaluation and outcome of patients admitted for syncope over a 1 year period.

AIMS: Syncope is a frequent and potentially dangerous symptom. The epidemiological data are based on series mainly collected 20 years ago in the U.S.A. and do not adequately assist in the management of patients admitted now for this symptom in Europe. METHODS AND RESULTS: To evaluate prospectively the epidemiological aspects and the management of the patients admitted in the emergency department of an adult university hospital for a 'verified' syncope, charts of all the patients consecutively admitted between June 1999 and June 2000 were systematically reviewed by a member of the cardiology staff. Those with a loss of consciousness were selected and those with a definite syncope were included in the study group and followed until they were discharged from the hospital. Among the 37,475 patients who presented to the emergency department, 454 (1.21%) had a definite syncope. For 296 it was the first episode and 169 (mean age 43+/-23 years) were discharged straight away; 285 (mean age 66+/-19 years; P<0.0001) were admitted to internal medicine (n=151), cardiology (n=65), neurology (n=44), endocrinology (n=14) and surgery (n=11) services. In 75.7% of all the patients a diagnosis was reported but it was inadequate to explain a syncopal episode in 56 cases (16.3%). Management differed by department: 36% of the patients had 'neurological' investigations mainly in internal medicine and neurology. Except in cardiology very few had 'cardiological' investigations particularly tilt test and electrophysiological studies (5%). CONCLUSION: Syncope is a frequent symptom but its cause often remains unknown partly due to inadequate management. Precise and simple guidelines are urgently needed.