Not long ago in the morning, her teenage daughter suddenly turned black in front of her eyes and fainted to the ground. We called an ambulance to take her to the emergency department. She had an electrocardiogram and blood test. The doctor advised her to go home for follow-up and said Alexa was very healthy, but to prevent syncope again, she should be careful not to be too hungry or short of water.
The most fortunate thing for me is that my daughter does not need to be hospitalized. A study published in April this year by JAMA Internal Medicine found that hospitalization does more harm than good to patients with low-risk syncope.
Doctors usually use the “San Francisco Syncope Rule” to screen patients who are not prone to complications in a short period of time after syncope and do not need hospitalization. However, one third of patients with low-risk syncope will still be hospitalized.
Shamai Grossman, associate professor of emergency department at Harvard Medical School, has rich clinical research experience in syncope. He said: “In the United States, although it is not necessary, most patients are still admitted because doctors are worried that they may have potential life-threatening diseases.”
Research on New Discoveries
Syncope is a sudden loss of consciousness caused by cerebral insufficiency and can recover itself in a short period of time. About 1/3 of hospitalized patients are not prone to short-term serious complications such as heart failure and arrhythmia.
Researchers at Johns Hopkins University followed up 200 patients hospitalized after syncope, aged between 19 and 97 (average 61).
The average hospitalization time of these low-risk syncope patients is 2 days. During this period, they will complete a series of examinations such as head CT, magnetic resonance, cardiac ultrasound and spinal radiography.
If it is a low-risk patient, are these examinations and evaluations necessary?
Dr. Deepak Bhatt, editor-in-chief of Harvard Heart Letter and a cardiologist, said: “It is often necessary to go through a comprehensive medical evaluation to judge a complete loss of consciousness. If the weather is just hot and you feel dizzy after not eating or drinking all day, you don’t need to do these tests.”
Risk of overtreatment
In this study, a small number of patients were diagnosed with serious diseases after hospitalization, but more patients with low-risk syncope had more risks than benefits during hospitalization.
For example, 23 low-risk syncope patients in the study came up with [accidental findings of unknown clinical significance] after examination. In other words, These tests found illnesses of little clinical significance, such as calcification of lymph nodes, asymptomatic spinal fractures and leukoencephalopathy. These tests are inconvenient and expensive, but ultimately have little effect on identifying the cause of syncope, even causing anxiety in patients and bringing more meaningless tests.
Moreover, some problems will not occur in patients with low-risk syncope if they are not hospitalized. For example, 9 patients (most of the elderly) suffered from blood transfusion errors, falls, delirium, medication errors and complications of intravenous infusion or indwelling catheterization.
Hospitalization is not cheap either. [A recent study showed that the average daily hospitalization cost for a syncope patient is US $2,420 and the daily cost for emergency visits is US $1,400,] Grossman pointed out. In addition, hospitalization for low-risk syncope patients also takes up medical resources.
Syncope risk assessment
Sometimes there is no need to worry too much about syncope. Vagus nerve stimulation can cause syncope by urinating hard, drawing blood, giving injections, hearing bad news, or even laughing. This kind of syncope is also called [vasovagal syncope], which is more likely to affect young people.
Sometimes, the cause of syncope is difficult to determine. Grossman said: “About half of the patients cannot determine the cause of syncope. We will recommend low-risk patients to go home for recuperation. They will often have further examination in the outpatient department, but still cannot find the cause.”
However, syncope should not be ignored, especially when it is the first time or accompanied by other symptoms. For example, chest pain or dyspnea before and after syncope, which may be heart disease. Severe diseases such as ruptured aneurysms, gastrointestinal bleeding or ruptured ectopic pregnancy can also cause syncope.
What kind of situation needs hospitalization after syncope? Grossman said: “You cannot evaluate for yourself. You need a physician to evaluate whether this syncope is at risk. Because going to the emergency department for syncope does not mean you need to be hospitalized.”
Grossman advises patients to consult a doctor if there is any danger if they go home.