Most Common Cause Of Syncope In Elderly – Falls in the elderly represent a major health and social concern, especially for their traumatic consequences and head injuries (HT) among them. The difficulty in gathering a reliable description of the event and the tendency of concerned clinicians to focus primarily on the consequences of the trauma rather than its mechanism hampers the ability to identify the cause of falls in the elderly. Appropriate preventive interventions. Syncope is reported in the literature as a minor cause of fall trauma in the elderly, although no studies have specifically investigated this item from the perspective of head trauma. In addition to outcomes, we tested in a one-month prospective study a short diagnostic protocol (<24 hours) aimed at defining the cause of falls in elderly people with head trauma, focusing primarily on anesthetic capacity and secondarily on synchrony. Diagnostic work. Unlike the usual ER diagnostic approach to HT, derived from a retrospective analysis of a four-month period in the same ER (control group), the study diagnostic protocol showed that syncope was significantly more frequent than expected (42% vs. 14%, p < 0, 01) in these patients. If these results are confirmed, syncope may be considered the leading cause of HT due to falls in the elderly, encouraging ER physicians to implement their HT protocols with a more extensive cause-oriented workup for this group of patients.

Falls represent one of the most challenging problems in the elderly population as well as a major health problem, in fact about 35% of people over the age of 65 experience at least one fall each year. Within this category, falls are responsible for the vast majority of concussions (about 80%) and are the most common cause of traumatic brain injury (TBI).

Most Common Cause Of Syncope In Elderly

Most Common Cause Of Syncope In Elderly

. TBI in the elderly has severe consequences in terms of mortality and morbidity as well as healthcare costs and is responsible for a large, ever-increasing number of emergency department (ER) admissions and hospitalizations.

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. Furthermore, a history of a single fall is a major risk factor for a subsequent new fall, increasing the risk of recurrent TBI.

. The public health and socio-economic consequences of fall injuries in the elderly, and TBI in particular, dictate appropriate preventive intervention policies that can only arise from a thorough understanding of the causes and mechanisms of falls.

. Indeed, in the overcrowded ER, the diagnostic workup of the traumatic brain injury patient focuses primarily on the consequences rather than the cause of the trauma, and the cause of the fall is usually attributed by the primary care provider. Patient without appropriate thorough evaluation. Moreover, elderly people often do not remember fall mechanisms and sometimes suffer from amnesia, before or after the injury, anamnesis, the most useful tool to explain the cause of the trauma, is often useless or too complicated and anyway too time-consuming. Overcrowded Emergency Department (ED)

. Understanding the cause of falls in the elderly is very challenging and indeed there is considerable diagnostic overlap between accidental falls and syncope.

Pdf] Syncope In Older Adults

, mainly because of the low reliability of routine medical history collection, the UK national STARS program (Syncope Trust And Reflex Anoxic Seizures) has developed a questionnaire to be presented to patients, with their relatives and sometimes witnesses to the events aimed at filling them out. Explain the cause of the fall better

. By careful interpretation of the answers, the clinician should be able to rule out syncope or consider it a certain or high probability. Today, sudden falls are considered the main cause of head trauma in the elderly, accounting for about 70% of them, and concussions are estimated to be responsible for only 2–20%, but such evidence is emerging from observational studies and institutional is The registry is not designed to explain the cause and mechanism of the crash

. Furthermore, head trauma as a result of uncontrolled syncopal flop-down can be expected to occur more frequently than other forms of trauma. This assumption is relevant in everyday ER practice, if never proven. Based on the above considerations, it can be argued that syncope may occur more often than reported as a cause of head trauma in the elderly. We then undertook a study using a systematic diagnostic approach aimed at estimating the true prevalence of syncope as a cause of fall and head injury in adults and compared the results with retrospective data from the same ER. The study was approved by the local ethics committee (prot. 2133/CE, 01/13/2015).

Most Common Cause Of Syncope In Elderly

For this purpose, all elderly people over 65 years of age, complaining of head trauma due to fall as the main complaint, presented to the ER of AOU Sassari (Azienda Ospedaliera Universitaria), Italy, consecutively for one month in May 2014. Studied from the point of view. Study protocol: After the initial ER evaluation, the entire study population underwent a 24-hour diagnostic work-up in the ED observation unit (OBI), identifying the possible cause of the fall, identifying the end of the pathway. The four different mechanisms are categorized below (see Diagnosis). ER physicians, unaware of the study objective and uniquely asked to act normally, transfer all patients with the aforementioned symptoms to a local OBI at the end of a routine ER clinical pathway consisting of a general and neurophysical examination, a brief history, 12-lead ECG, Head The emergency physician believed that a CT scan and any other examination was appropriate per local head trauma protocol. This ER evaluation represents the usual care for these types of problems at our institution. The subsequent OBI work-up consisted of 12 hours of continuous telemetry ECG monitoring, clinical observation, blood tests as appropriate, a second CT scan if necessary, and, in particular, an in-depth analysis involving relatives and eyewitnesses. The STARS questionnaire was clearly translated from Italian. After STARS questionnaire interpretation and in-depth analysis with clinical and 12-hour ECG monitoring, if the cause of transitory transient loss of consciousness or fall with definite or high probability for head trauma has not been determined, patients undergo synchronous diagnostic work-up in accordance with the guidelines of the European Union of Cardiology was done

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. At the end of the OBI pathway, patients were discharged home or, in case of complications or diagnoses requiring further intervention, transferred to definitive therapy. The above diagnostic path is considered the study of “OBI diagnostic protocol” (fig. 1).

To compare the OBI diagnostic protocol with the usual care diagnostic work-up, we reanalyzed all patients with the same characteristics in the study population who presented consecutively to the same ER in the previous year (March to March). June 2014). All patients treated according to the local standard of care for this type of problem as described above. Causes of falls are then described and shared from ER medical records

In both groups, consistent with study objectives, patients with head trauma secondary to causes other than falls (ie, street accidents, assaults, etc.) were excluded.

At the end of the diagnostic task, each fall in both groups was attributed to one of the four mechanisms mentioned above.

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Continuous data are expressed as mean (SD). Chi-square tests were used to compare syncopal (definite and probable) falls (accidental, uncertain and other) with all other causes of falls to assess differences between groups. P values ​​less than 0.05 were considered statistically significant.

The study group consisted of 24 patients over 65 years of age who presented at the ER during one month (May 2015) consecutively for head trauma as mayor injury due to fall. All 24 patients (mean age 79+/- 3; 42% male) underwent the OBI diagnostic protocol as described above. At the end of the OBI diagnostic protocol, the causes of falls were revealed as follows: 6 accidental, 10 syncopal, 5 other causes and 3 indeterminate. Thus, syncopal causes resulting from head trauma accounted for 42% of the total falls (fig. 2). Among the 10 synchronized falls, 2 were identified as cardiogenic (high heart rate in paroxysmal atrial fibrillation), 5 due to orthostatic hypotension and 3 reflex (2 vasodepressive and 1 cardioinhibitory requiring pace-maker implantation). The other 5 critical causes included two postural instability, one dizziness, one hyponatremia, and one alcohol poisoning. All head injuries were classified as mild (GCS 15) according to the Glasgow Coma Scale (GCS) but one was classified as moderate (GCS 13), and head CT scan revealed six of 24 posttraumatic brain injuries (one subarachnoid hemorrhage). ) was detected. , three subdural hematomas, one with surgical resection, one with intraparenchymal hemorrhage, and one with frontal trauma). Three of the six head traumas with brain injury (50%) were due to syncope and two (33%) were on warfarin. Seven of the 24 patients were eventually hospitalized (29%): six in the emergency medicine ward and one in neurosurgery.

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