Evaluation of Patients with “Faint” in an American Teaching Hospital: A Dire Need for a Standardized Approach

Background: Fainting is a major healthcare problem with significant morbidity, mortality, and healthcare cost. We sought to assess the appropriateness of current clinical practice when compared to a guideline-based algorithm.

Methods: The records of 100 consecutive patients who presented with faint and were referred to the University of Utah for further evaluation by specialists were reviewed. We analyzed the clinical characteristics, tests performed, diagnosis made, and number of admissions. In addition, we applied a guideline-based algorithm to assess the appropriateness of these evaluations.

Results: The mean age was 49 ± 21 years with 57% being female. One-third presented with their first event. Structural heart disease was present in 22% of the cases. Twelve (36%) of 32 admissions were inappropriate. There was an underutilization of orthostatic testing, carotid sinus massage, and implantable loop recorder and overutilization of imaging studies and neurologic consultation. Specifically, active standing and tilt-table testing were performed in only 24% and 7% of the cases, respectively, none of the patients had carotid sinus massage despite 26% of them being ≥65 years old, and only 3% of the patients received an implantable loop recorder. With the current practice, a final diagnosis was made in 45 cases with 17 (38%) of the 45 final diagnoses not being sufficiently supported by the completeness of the evaluation.

Conclusion: With the current practice at a major university hospital, the cause of faint was unexplained in a high number of cases. Our findings highlight the need for a standardized approach to patients presenting with faint. (PACE 2011; 34:284–290)