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The low prevalence of pulmonary embolism in patients with syncope: What should clinicians do?

Published:February 27, 2018DOI:https://doi.org/10.1016/j.ajem.2018.02.037
      After the Pulmonary Embolism in Syncope Italian Trial (PESIT) showed a 17% prevalence of acute pulmonary embolism (APE) in patients hospitalized with first syncope [
      • Prandoni P.
      • et al.
      Prevalence of pulmonary embolism among patients hospitalized for syncope.
      ], multiple consequent studies and meta-analysis revealed this prevalence to be <3% [
      • Verma A.A.
      • et al.
      Pulmonary embolism and deep venous thrombosis in patients hospitalized with syncope: a multicenter cross-sectional study in Toronto, Ontario, Canada.
      ,
      • Costantino G.
      • et al.
      Prevalence of pulmonary embolism in patients with syncope.
      ,
      • Oqab Z.
      • Ganshorn H.
      • Sheldon R.
      Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis.
      ], thereby, discouraging the adoption of a routine protocol for excluding APE in such instance. While we definitely agree from our experience that the prevalence of APE among all cases presenting with syncope is extremely low (<1% in the Costantino Study and meta-analysis by Oqab and colleagues), we still advocate that clinicians maintain a reasonable index of suspicion for diagnosing APE especially in cases presenting with syncope.
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      References

        • Prandoni P.
        • et al.
        Prevalence of pulmonary embolism among patients hospitalized for syncope.
        N Engl J Med. 2016; 375: 1524-1531
        • Verma A.A.
        • et al.
        Pulmonary embolism and deep venous thrombosis in patients hospitalized with syncope: a multicenter cross-sectional study in Toronto, Ontario, Canada.
        JAMA Intern Med. 2017; 177: 1046-1048
        • Costantino G.
        • et al.
        Prevalence of pulmonary embolism in patients with syncope.
        in: JAMA Intern Med. 2018
        • Oqab Z.
        • Ganshorn H.
        • Sheldon R.
        Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis.
        Am J Emerg Med. 2017; https://doi.org/10.1016/j.ajem.2017.09.015
        • Omar H.R.
        • et al.
        Syncope on presentation is a surrogate for submassive and massive acute pulmonary embolism.
        Am J Emerg Med. 2018; 36: 297-300