Pulmonary Embolism presenting as Syncope : Scare mongering at best

PESIT INVESTIGATORS published in this week of NEJM, reported that 17.3% of patients had PE who were admitted with first syncope to the hospital. This study has been circulated in various newspapers (1, 2, 3) as if  physicians are missing the big deadly cause of fainting spells, which is plain scare mongering.

Emergency room physicians are already overusing the CT pulmonary angiograms, increasing the cost and exposure of radiation and dye. Many of them never use Well’s score to rule out the PE.

 

STUDY IN NUTSHELL

pesit

CRITICAL POINTS

  1. Majority of the patients presenting with syncope were safely discharged home using ESGYS score.
  2. More than half of admitted patients who were enrolled in study were ruled out for PE using Well’s score.
  3. Study did not utilize age adjusted D dimer cut off which can increase accuracy.
  4. CT angiograms often overdiagnose PE.
  5. Syncope as presenting symptom is seen in about 10% to 13% of pulmonary embolism patients. (4,5,6)
  6. When syncope is presenting feature in PE, it is associated with lower mortality.

RS