Bhat et al identified factors which can help to identify a patient with cardiac syncope who presents with trauma to the Emergency Department. These can help to identify patients who may benefit from a more complete evaluation. The authors are from Case Western Reserve University in Cleveland.

Patient selection: Emergency Department patient after traumatic fall


Syncope was defined as a transient loss of consciousness with inability to maintain postural tone, followed by spontaneous recovery.


Cardiac syncope may be due to a cardiac dysrhythmia or valvular abnormality.


Features associated with cardiac syncope:

(1) age > 65 years

(2) presence of coronary artery disease

(3) pathological Q waves in the ECG (Q wave >= 1 mm in depth and present in >= 2 contiguous leads)


The presence of 1 or more features was 100% sensitive and 43% specific, with a negative predictive value of 100%. The area under the ROC curve was 0.80.


This could be modified by adding heart murmur or history of valve disease (to reflect valvular abnormality). Additional abnormal findings on the ECG might also raise the issue (the authors also studied prolonged QRS duration or prolonged QT interval). Also there should not be a better explanation for fall such as intoxication.


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