Last year, we suffered the ignominy of being presented with evidence implying the Emergency Department was systematically failing to adequately evaluate the underlying etiology of patients with syncope. The PESIT trial demonstrated nearly 1 in 6 patients admitted to the hospital had PE, and, worse, most had obvious clinical manifestations of VTE. This is, despite its publication in the New England Journal of Medicine, still nonsense, and flies in the face of every other reasonable estimate of the prevalence of PE.
This study is yet another reasonable refutation of their inflated estimate: a retrospective, secondary re-analysis of a prospectively-collected syncope data set. This analysis reviewed 348 patients previously enrolled in the Emergency Department with a presenting complaint of syncope, about half of whom were observed or admitted to the hospital. Overall, just two of the original 348 were diagnosed with PE in the ED. None of the patients admitted or observed were diagnosed with PE during their hospitalization, but, in their 30-day follow-up period, three total additional PE diagnoses were made.
Without a systematic process for excluding PE, it is reasonable to suggest these numbers are biased towards under-estimating the diagnosis of PE – although the patients in question with 30-day PE each underwent objective testing during their initial presentation with either D-dimer or CTPA. Regardless, the rate of PE in patients hospitalized with syncope is far below the 1 in 6 prominently reported – and we might do well to expunge it from our collective memory.
“Prevalence of pulmonary embolism in patients presenting to the emergency department with syncope”