In this large observational study of 2106 patients >65 years admitted for syncope, researchers evaluated the frequency, yield, and cost of common diagnostic tests. The most commonly performed tests included EKG (99%), telemetry (95%) and cardiac enzymes (95%). All of the following tests affected diagnosis, management, or determined etiology in <5% of cases: Echo, cardiac enzymes, CT scans, carotid USG, and EEG. Postural BP affected diagnosis or management or etiology between 15-30% of cases. EEG, CT scans and cardiac enzymes were the least cost effective, and postural BP was the most cost effective (but was only performed in 38% of cases). A step-wise approach to diagnostic testing (after careful history, exam, and postural BP testing) should be utilized in older patients with syncope (abstract).
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