National trends in resource utilization associated with ED visits for syncope

Background Over the last 20 years, numerous research articles and clinical guidelines aimed at optimizing resource utilization for emergency department (ED) patients presenting with syncope have been published. Hypothesis We hypothesized that there would be temporal trends in syncope-related ED visits and associated trends in imaging, hospital admissions, and diagnostic frequencies. Methods The ED component of National Hospital Ambulatory Medical Care Survey was analyzed from 2001 through 2010, comprising more than 358 000 visits (representing an estimated 1.18 billion visits nationally). We selected ED visits with a reason for visit of syncope or fainting and calculated nationally representative weighted estimates for prevalence of such visits and associated rates of advanced imaging utilization and admission. For admitted patients from 2005 to 2010, the most frequent hospital discharge diagnoses were tabulated. Results During the study period, there were more than 3500 actual ED visits (representing 11.9 million visits nationally) related to syncope, representing roughly 1% of all ED visits. Admission rates for syncope patients ranged from 27% to 35% and showed no significant downward trend (P =.1). Advanced imaging rates increased from about 21% to 45% and showed a significant upward trend (P <.001). For admitted patients, the most common hospital discharge diagnosis was the symptomatic diagnosis of "syncope and collapse" (36.4%). Conclusions Despite substantial efforts by medical researchers and professional societies, resource utilization associated with ED visits for syncope appears to have actually increased. There have been no apparent improvements in diagnostic yield for admissions. Novel strategies may be needed to change practice patterns for such patients.