If you’ve ever seen someone lose consciousness, it’s frightening and disturbing—even after the person wakes up. The medical term for this phenomenon is syncope.
Physicians and healthcare providers define syncope as a sudden transient loss of consciousness with a spontaneous recovery. According to recent data from the Annals of Emergency Medicine, episodes of adult syncope account for 1.2–1.8 million emergency room visits annually in the United States.
There’s no single answer to explain why someone experiences syncope. Of those patients who seek medical care after an episode of syncope, for fully one-third of them a cause is never identified. Some causes are cardiovascular, others are neurologic. For those who have a cardiovascular cause, syncope is a warning sign of increased risk of death and the need for medical attention and management.
This means that it’s appropriate to have a thorough medical workup after syncope occurs. Physicians should start with a thorough conversation with the patient to obtain a history, including any signs and symptoms that preceded the syncopal occurrence.
The physical exam focuses on a variety of factors, including investigating the effect of a change in body position (standing or sitting) and in the abnormal neurologic symptoms.
For many patients experiencing syncope, radiology imaging is necessary. The American College of Radiologists recently issued guidelines detailing the appropriateness of different imaging studies for syncope patients.
The criteria differentiate between patients who are suspected to have cardiovascular factors causing or contributing to syncope, and those for whom there’s no cardiovascular cause.
Imaging for syncope when there’s a cardiovascular suspicion
For patients for whom the ordering physician has a suspicion of a cardiovascular cause of syncope, based on patient history, physical examination or electrocardiogram (ECG) findings, the only study that the College describes as “usually appropriate” is ultrasound echocardiography transthoracic resting.
The guidelines note that these additional imaging studies “may be appropriate”: CT angiogram chest with IV contrast, chest radiography, CT angiogram coronary arteries with IV contrast, MRI heart function and morphology without and with IV contrast, and MRI card function and morphology without IV contrast.
According to the guidelines, all other imaging is usually not appropriate.
Imaging for syncope when there’s not a cardiovascular suspicion
When the ordering physician feels that there was a low probability of a cardiovascular explanation for a patient’s syncope, the American College of Radiologists only has one recommendation that “may be appropriate,” radiography of the chest. According to the guidelines, all other imaging is usually not appropriate.
The failure to perform an appropriate medical workup after a patient presents to a hospital, doctor’s office, or emergency room for evaluation of syncope can be deviation from the standard of care in medical malpractice. It can also be medical malpractice to order the wrong type of diagnostic radiology imaging, or none at all. If this has happened to you in Texas, and has caused serious injury, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.
