N. L. Bandy1, T. J. Novosel1, J. R. Burgess1 1Eastern Virginia Medical School,Dept Of Surgery,Norfolk, VA, USA
Introduction:
Falls represent a significant portion of the US trauma population. The etiology of a fall is often ambiguous. Frequently concern exists for a syncopal event which can lead to extensive diagnostic testing. Previously published data have demonstrated limited utility for routine syncopal evaluation. However, the practice remains common in many trauma centers. This study evaluates the utility of routine carotid duplex ultrasound and echocardiogram in trauma patients with a GCS of 15 who were admitted after a fall.
Methods:
The trauma patient registry from a level one trauma center was retrospectively analyzed. Patients were included if they had a GCS of 15, diagnosis of fall, carotid duplex ultrasound, and a trans-thoracic echocardiogram ordered during the evaluation for suspected syncope. Patients who were not admitted to the trauma service were excluded. 50 patients were included in the study. Medical co-morbidities were compared between those with positive findings on diagnostic testing and the overall study population.
Results:
405 admissions were reviewed to capture 50 patients who met inclusion criteria. Of these, 14 (28%) had significant findings on duplex ultrasound. However, none of these patients required inpatient intervention and only four (8%) were referred for outpatient follow up. None of the lesions discovered on carotid duplex ultrasound were felt to be causative of syncope. Of the 50 echocardiograms, 10 (20%) had hemodynamically significant pathology. Two of these patients (4%) required inpatient intervention and four (8%) were referred for outpatient follow up only. Only one patient was discovered to have a lesion on echocardiogram considered to be reasonably causative of a syncopal event. There were no significant differences in baseline co-morbidities between the study population and those with positive findings on duplex ultrasound or echocardiogram.
Conclusion:
Routine carotid duplex and echocardiogram studies continue to be ordered frequently on the neurologically intact trauma patient with possible syncope despite low diagnostic utility. More stringent care protocols are needed to better allocate resources within the trauma system and increase the positive predictive value when advanced imaging studies are obtained.