Syncope and head trauma in elderly: a pilot study
In order to compare the OBI diagnostic protocol to the usual care diagnostic work-up, we retrospectively analysed all the patients with the same characteristics of the study population that consecutively presented to the same ER during a four months period of the year before (March to June 2014). All the patients where treated in accordance with the local standard of care for these kind of problems, as described above. The causes of fall were then extrapolated from the ER medical reports and divided into
the 4 mechanisms (causes) listed below.
This diagnostic work-up was considered the “usual care”.
In both groups, in agreement with the study objectives, patients with head trauma secondary to causes different from fall (ie. street accidents, aggressions, etc.) have been excluded.
Causes of fall have been divided into 4 categories listed below:
1. Syncopal (certain and very likely)
2. Accidental (due to environmental/external causes)
3. Other determinate causes of fall (specified)
Each fall in either group, at the end of the diagnostic work-up, has been attributed to one of the above mentioned four mechanisms.
Continuous data have been expressed as mean (SD). Chi-square tests were used to compare categorical data of syncopal (either certain and very likely) falls vs all other causes of fall (accidental, indeterminate and other) in order to evaluate the difference between groups. P values below 0.05 were considered statistically significant.
The control group comprised 134 patients, 65 years old or more (mean age 77 +/- 4; males 44%), consecutively presented at the same ER from March to June 2014 for head trauma secondary to fall and treated in accordance with the local head trauma protocol (standard of care). The distribution of the causes of falls extrapolated from ED medical reports was as follow: 76 accidental, 19 syncopal, 17 others, 22 indeterminate. Syncopal episodes accounted for only 14% of total, whereas accidental falls,
accounting for the 57% of causes, were the most frequent (Fig. 3).
No further investigation aimed to find syncope aetiology was reported in this retrospective group.
|Causes of fall (diagnosis)||Study Group n=24 (%)||Control Group n=134 (%)|
|Accidental||6 (25)||76 (57)|
|Syncopal||10 (42)||19 (14)|
|Other||5 (21)||17 (13)|
|Indeterminate||3 (12)||22 (16)|
|OBI diagnostic protocol
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