Utility of Chest Radiography in Emergency Department Patients Presenting with Syncope
Abstract
Background: Syncope has myriad etiologies, ranging from benign to immediately life threatening. This frequently leads to over testing. Chest x-rays are among these commonly performed tests despite their uncertain diagnostic yield.
Objectives: To quantify the distribution of normal and abnormal chest x-rays in patients presenting with a chief complaint of syncope, stratified by those who did or did not have an adverse event at thirty days.
Methods: Prospective cohort of consecutive patients presenting to an urban tertiary care academic medical center with a chief complaint of syncope from 2003-2006. The frequency and findings for each CXR were reviewed, as well as ED and hospital discharge diagnoses as well as thirty-day outcome.
Results: There were 575 total subjects, 39.7% were male, and the mean age was 57.2 (SD 24.6). Of the 575 total subjects, 403 (70.1%) had chest x-rays performed, and 116 (20.2%) had an adverse event after their syncope. Of the 116 people who had an adverse event, 15 (12.9%) had a positive CXR, 81 (69.8%) had a normal CXR, and 20 (17.2%) did not have a CXR as part of the initial evaluation. Among the 459 people who did not have an adverse event 3 (0.7%) had a positive CXR, 304 (66.2%) had a normal CXR, and 152 (33.1%) did not have a CXR performed.
Conclusions: Among patient who had an adverse event after their syncope, the majority of patients had a normal CXR. More data is needed to validate this conclusion.