Point-of-Care Ultrasound in the Emergency Department Evaluation of Syncope

• Time to Final Emergency Department Disposition [ Time Frame: Time at which an admit or discharge order is placed within the electronic medical record (estimated 2-3 hours) ] [ Designated as safety issue: No ]
  

• Time to therapeutic intervention [ Time Frame: At onset of therapeutic interventions including but not limited to intravenous fluids and medications (estimated time frame 0 - 6 hours) ] [ Designated as safety issue: No ]
  
• Time to clinical procedure [ Time Frame: At onset of clinical procedures including but not limited to central line placement, pericardiocentesis, thoracentesis, etc. (estimated time frame 0-6 hours) ] [ Designated as safety issue: No ]
  
• Number and Type of other imaging studies [ Time Frame: End of Emergency Department Encounter (estimated time frame 1- 6 hours) ] [ Designated as safety issue: No ]
  Other imaging studies to included radiographs, additional point-of-care ultrasound, computed tomography, etc.
  
  
• Information Content provided by Point-of-Care Ultrasound [ Time Frame: After performance of point-of-care ultrasound (estimated time frame 1- 6 hours) ] [ Designated as safety issue: No ]
  calculating from pre and post test probability estimates and the number of diagnoses
  
  
• Number and type of laboratory studies [ Time Frame: estimated time frame 0-6 hours ] [ Designated as safety issue: No ]
  
• Number of and time to consultant services [ Time Frame: estimated time frame (0-6 hours) ] [ Designated as safety issue: No ]
  Number of consults obtained and the time frame in which the consults were performed
  
  

• Short Term Adverse Outcome [ Time Frame: 7 days from Emergency Department Visit ] [ Designated as safety issue: Yes ]
  Adverse outcome defined as death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing a return ED visit and hospitalization for a related event.
  
  

Syncope is one of the more common presentations to the Emergency Department, representing between 1.2-1.5% of all evaluated patients and up to 6% of admissions. Due to an often broad and overlapping differential diagnosis, syncope represents a disease entity that often requires extensive workup. This typically involves laboratory tests, EKGs, x-rays, computed tomography, or other studies that are costly, time-consuming, and, in the case of diagnostic imaging, frequently involves ionizing radiation. Yet, despite extensive testing, an exact diagnosis is not made in up to 50% of cases.

Cardiac causes of syncope include myocardial infarction, pericardial effusion, volume depletion, arrhythmia, among other entities, many of which are life threatening. Echocardiography (cardiac ultrasound) has been used for inpatient syncope evaluations for several decades. In the Emergency Department, echocardiography is currently being used at the point-of-care (POC) in a limited and focused approach to a variety of conditions. However, POC ultrasound has never been systematically evaluated as a diagnostic or prognostic tool specifically for syncope in the Emergency Department. We aim to determine if an ultrasound-based protocol is effective as an adjunct in the evaluation of syncope. Our research study will examine the utility of POC ultrasound in the diagnosis, imaging and laboratory utilization, and prognosis of syncope in the Emergency Department.