The diagnostic efficiency of whole-body bedside ultrasonography protocol for syncope patients in the emergency department

Background: The emergency physician should diagnose and treat the critical illnesses that cause syncope/ presyncope in patients presenting to the emergency department (ED). Whole-body ultrasonography can detect the critical etiology of syncope with high diagnostic sensitivity. We aimed to reveal whether whole-body ultra-sonography for syncope (WHOBUS-Syncope) protocol recognizes high-risk syncope patients and the effect of WHOBUS-Syncope protocol on the management of patients.Method: This is a prospective, cross-sectional study. Patients over the age of 18 years who presented to the ED with syncope or near syncope were included consecutively. Carotid, lung, cardiac, collapsibility of inferior vena cava, abdominal and compression ultrasonography of the lower extremity veins was performed among the WHOBUS-Syncope protocol. Frequency of abnormal sonographic findings associated with syncope/presyncope and requirement of critical intervention for abnormal sonographic findings were assessed.Results: 152 patients were included in the study. The median age of the patients was 61.5 years (IQR: 41-71.8) and 52.6% were female. The most common (64.3%) abnormal sonographic finding was >50% collapse of vena cava inferior during inspiration. In addition, abnormal sonographic findings thought to cause syncope/ presyncope were detected in 35.5% of the patients. Bolus fluid resuscitation were given in in 62 patients (40.8%) with increased inferior vena cava collapse. Critical interventions other than fluid resuscitation were per-formed for abnormal sonographic findings in 35 (23%) of the patients. Advanced age, increased heart rate and the presence of high-risk criteria in the 'European Society of Cardiology Guidelines for Syncope' were independent risk factors for detection of abnormal ultrasonographic findings related to syncope/presyncope.Conclusion: WHOBUS-Syncope protocol can be included in emergency practice as part of the standard evaluation in patients with syncope or presyncope presenting to the ED.(c) 2023 Elsevier Inc. All rights reserved.