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ED Patients With Syncope Should Undergo Chest X-Rays


Chest X-rays should be ordered for patients who present to the ED with syncope.

Patients presenting to the emergency department with complaints of syncope should still undergo routine chest X-rays, according to a study published in the Western Journal of Emergency Medicine.

Researchers from Harvard Medical School, Beth Israel Deaconess Medical Center, in Boston, MA, sought to study the distribution of normal and abnormal chest radiographs in patients presenting with syncope, stratified by those who did or did not have an adverse event at 30 days.

The study included 575 patients, 39.7% male. The mean age for all patients was 57.2 years. The researchers assessed the frequency and findings for each CXR, as well as emergency department and hospital discharge diagnoses, and 30-day outcome.

A total of 403 (70.1%) CXRs were performed on the 575 subjects, and 116 (20.2%) of the patients had an adverse event after their syncope.

Patients With Adverse Event n=116
Patients Without Adverse Event N=459
Positive CXR
15 patients (12.9%)
3 (0.7%)
Normal CXR
81 patients (69.8%)
304 (66.2%)
No CXR Performed in initial evaluation
20 patients (17.2%)
152 (33.1%)







Fifteen of the 18 patients (83.4%) with an abnormal CXR had an adverse event. Eighty-one of the 385 patients (21.0%) with a normal CXR had an adverse event. Among those who had a CXR performed, an abnormal CXR was associated with increased odds of adverse event.

The researchers concluded that patients with syncope who have abnormal CXRs are more likely to experience an adverse event, though the majority of CXRs performed in the work up of syncope are normal.

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