Retrospecti̇ve analysis of cranial imaging in patients admitted to the emergency department with syncope

In this study, we aimed to describe the pathological findings and investigate possible risk factors related to abnormal cranial imaging in patients presenting to the emergency department with syncope. A total of 2000 sycope patients who applied to the emergency departments of two tertiary referal hospitals located in Bursa and underwent cranial imaging (CT or MRI scan) were retrospectively analyzed. Patients whose primary complaint was not compatible with syncope, under 18 years of age, those with conditions such as hypoglycemia, seizure, conversion, trauma, coma, persistent loss of consciousness, alcohol or substance use and known intracranial pathology were excluded from the study. Data analysis was done with SPSS v22 package program. 1394 patients (672 men and 722 women; range, 18 – 96 years; mean 57.5 years) were included in the study. Pathological findings related to syncope were observed in a total of 523 (37.5%) patients; 151 (10.8%) cranial CT and 372 (26.7%) cranial MRI. The following risk factors were found to be significantly corrrelated with pathologic cranial imaging results; focal neurological deficit, high blood pressure, neurological symptoms, coagulopathy, increased levels of acute phase reactans, elevated serum troponin levels, atrial fibrillation, anemia and presence of additional illness (malignancy, hypertension, diabetes, cerebrovascular disease). Emergency physicians often resort to cross-sectional imaging methods to avoid missing life-threatening intracranial pathologies related to syncope. This situation exposes most patients to unnecessay radiation and increses healthcare costs. Identifying risk factors associated with abnormal cranial imaging has the potential to reduce the use of routine cranial CT and MRI in patients presenting to the emergency department with syncope.