Annals of Emergency Medicine
Volume 51, Issue 3 , Pages 240-246.e1, March 2008

Low Diagnostic Yield of Electrocardiogram Testing in Younger Patients With Syncope

  • Benjamin C. Sun, MD, MPP

      Affiliations

    • Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • Corresponding Author InformationAddress for correspondence: Benjamin Sun, MD, MPP, Office 3214A, Mail Stop 111, Building 500, Wing 3E, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd, Los Angeles, CA 90073; 310-268-3002, fax 310-268-4818
    • ,
  • Jerome R. Hoffman, MA, MD

      Affiliations

    • Emergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
    • ,
  • William R. Mower, MD, PhD

      Affiliations

    • Emergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
    • ,
  • Gil Z. Shlamovitz, MD

      Affiliations

    • Emergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
    • ,
  • Gelarah Z. Gabayan, MD

      Affiliations

    • Emergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
    • GZ Gabayan originally submitted this article under the name Gelarah Zargaraff.
    • ,
  • Carol M. Mangione, MD, MSPH

      Affiliations

    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • School of Public Health, University of California, Los Angeles, Los Angeles, CA.

Received 17 January 2007; received in revised form 7 March 2007 and 14 March 2007; accepted 6 April 2007. published online 13 June 2007.

Study objective

Routine ECG testing is recommended in the evaluation of syncope, although the value of such testing in young patients is unclear. For ECG testing, we assess the diagnostic yield (frequency that ECG identified the reason for syncope) and predictive accuracy for 14-day cardiac events after an episode of syncope as a function of age.

Methods

Adult patients with syncope or near-syncope were prospectively enrolled for 1 year at a single academic emergency department (ED). A 3-physician panel reviewed ED charts, hospital records, and telephone interview forms to identify predefined cardiac events. The primary outcome included all 14-day, predefined cardiac events including arrhythmia, myocardial ischemia, and structural heart disease.

Results

Of 592 eligible patients, 477 (81%) provided informed consent. Direct telephone contact or admission/outpatient records were successfully obtained for 461 (97%) patients, who comprised the analytic cohort. There were 44 (10%) patients who experienced a 14-day cardiac event. Overall diagnostic yield of ECG testing was 4% (95% confidence interval 2% to 6%). For patients younger than 40 years, ECG testing had a diagnostic yield of 0% (95% confidence interval 0% to 3%) and was associated with a 10% frequency of abnormal findings.

Conclusion

ECG testing in patients younger than 40 years did not reveal a cardiac cause of syncope and was associated with a significant frequency of abnormal ECG findings unrelated to syncope. Although our findings should be verified in larger studies, it may be reasonable to defer ECG testing in younger patients who have a presentation consistent with a benign cause of syncope.

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 Supervising editor: Allan B. Wolfson, MDAuthor contributions: BCS, JRH, WRM, and CMM conceived the study. BCS and CMM obtained funding for this study. BCS, GZS, and GZG were responsible for data collection and outcomes review, and BCS supervised the overall data collection process. BCS performed the data analysis and drafted the article. All authors contributed substantially to article revisions. BCS takes responsibility for the paper as a whole.Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was supported by the UCLA Robert Wood Johnson Clinical Scholars Program (050721). Dr. Sun is supported by a UCLA National Institute of Aging K12 Award (K12AG001004) and an American Geriatrics Society Dennis Jahnigen Career Development Award. Dr. Mangione was also partially supported by the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, NIH/NIA (AG 02-004).Publication dates: Available online June 7, 2007.Reprints not available from the authors.

PII: S0196-0644(07)00451-9

doi:10.1016/j.annemergmed.2007.04.006

Annals of Emergency Medicine
Volume 51, Issue 3 , Pages 240-246.e1, March 2008

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