CT for Syncope in Adults
Syncope or near syncope, in which someone feels faint, lightheaded, or passes out, is a common reason patients come to the emergency department for evaluation. Many different tests may be performed during the evaluation to identify the cause, although most of the time this is not serious. Guidelines recommend using a tailored approach informed by the medical history and physical examination. Increasingly, CT scans have been used as part of the evaluation but are limited in their ability to diagnose aside from neurologic problems such as bleeding in the brain or stroke, a generally rare cause of syncope. If there is concern for a head injury related to a fall from syncope, then guidelines recommend adhering to evidence-based clinical decision rules formulated for this purpose. In the absence of neurologic symptoms or concerns for severe head injury, CT scan of the brain should not be routinely obtained. This approach has been endorsed as a Choosing Wisely recommendation by the American College of Emergency Physicians. Within the Michigan Emergency Department Improvement Collaborative, we measure performance by reporting the proportion of CT scans for syncope that are concordant with guideline recommendations.