Point-of-Care Ultrasound in the Emergency Department Evaluation of Syncope

Syncope is one of the more common presentations to the Emergency Department, representing
between 1.2-1.5% of all evaluated patients and up to 6% of admissions. Due to an often broad
and overlapping differential diagnosis, syncope represents a disease entity that often
requires extensive workup. This typically involves laboratory tests, EKGs, x-rays, computed
tomography, or other studies that are costly, time-consuming, and, in the case of diagnostic
imaging, frequently involves ionizing radiation. Yet, despite extensive testing, an exact
diagnosis is not made in up to 50% of cases.

Cardiac causes of syncope include myocardial infarction, pericardial effusion, volume
depletion, arrhythmia, among other entities, many of which are life threatening.
Echocardiography (cardiac ultrasound) has been used for inpatient syncope evaluations for
several decades. In the Emergency Department, echocardiography is currently being used at
the point-of-care (POC) in a limited and focused approach to a variety of conditions.
However, POC ultrasound has never been systematically evaluated as a diagnostic or
prognostic tool specifically for syncope in the Emergency Department. We aim to determine if
an ultrasound-based protocol is effective as an adjunct in the evaluation of syncope. Our
research study will examine the utility of POC ultrasound in the diagnosis, imaging and
laboratory utilization, and prognosis of syncope in the Emergency Department.

Inclusion Criteria:

- 18 years and older presenting to the ED with acute syncope (defined as transient loss
of consciousness) or near syncope (sensation of impending but not actual loss of
consciousness) as a reason for ED visit.

Exclusion Criteria:

- persistent altered mental status

- alcohol or illicit drug-related loss of consciousness

- definite seizure, and transient loss of consciousness caused by head trauma.