Photo Credit: Pornpak Khunatorn

The following is a summary of “Diagnostic Efficiency of Whole-Body Bedside Ultrasonography in Syncope Patients: ED Study,” published in the May 2023 issue of Emergency Medicine by Ucar et al.

Patients who present to the emergency department (ED) with syncope or presyncope should be evaluated for and treated for the critical ailments that are the underlying cause. Ultrasonography of the entire body can detect the underlying cause of syncope with high diagnostic sensitivity. The researchers sought to determine whether the whole-body ultrasonography for syncope (WHOBUS-Syncope) protocol identifies high-risk syncope patients, as well as the protocol’s influence on patient management. This study is prospective and cross-sectional. Patients over 18 years old who presented to the ED with syncope or near syncope were included sequentially. 

Under the WHOBUS-Syncope protocol, carotid, pulmonary, cardiac, collapsibility of inferior vena cava, abdominal, and compression ultrasonography of the lower extremity veins were performed. They evaluated the frequency of aberrant sonographic findings associated with syncope/presyncope and the need for urgent intervention for abnormal sonographic results. Included in the research were 152 patients. The median age of the patients was 61.5 (IQR: 41–71.8), and 52.6% were female. The most prevalent abnormal sonographic finding (64.3%) was >50% vena cava inferior collapse during inspiration. In addition, abnormal sonographic findings believed to be the cause of syncope/presyncope were detected in 35.5% of patients. 

In 62 patients (40.8%) with enhanced inferior vena cava collapse, bolus fluid resuscitation was administered. In 35 (23%) patients, interventions other than fluid resuscitation were performed due to abnormal sonographic findings. Age, heart rate, and the presence of high-risk criteria in the ‘European Society of Cardiology Guidelines for Syncope’ were independent risk factors for detecting aberrant ultrasonographic findings associated with syncope/presyncope. The WHOBUS-Syncope protocol can be incorporated into emergency practice as part of the standard evaluation for patients presenting with syncope or presyncope.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000487