Pulmonary embolism prevalence in syncope patients brought to the emergency room by ambulance

Abstract views: 76 / PDF downloads: 39





Pulmonary embolism, syncope, prevalence



Aim: Cohort studies have shown that syncope is one in four of the initial symptoms of acute pulmonary embolism. However, one in six patients who visit the emergency room for their first syncopal attack has acute pulmonary embolism. Additionally, the etiological relationship between acute pulmonary embolism and the possible prognostic impact of syncope on the early clinical course of a patient with acute pulmonary embolism remains unclear. Our research sought to detect the presence of pulmonary embolism and its contributing factors in syncope patients who were admitted to the emergency room.

Material and Method: The study comprised 215 individuals who had syncope and were transported by ambulance to the emergency department between January 2020 and January 2021. The age bracket for inclusion was 18 to 75, and the presence of solitary syncope, regardless of its cause, was required. Additionally, there had to be no clinical signs of shock or hypotension, and/or absence of right ventricular dysfunction at presentation.

Results: A total of 215 patients were included in the study. The mean age was 57 years and 64% of the patients were female. Pulmonary CT angiography was performed in 37 of the patients. Ventilation-perfusion examination was performed on 2 patients. Pulmonary embolism was confirmed in 14 patients, including a lower segment pulmonary embolism. Pulmonary embolism was diagnosed in 7 of 17 patients with no history of active cancer and a previous history of thromboembolism. The prevalence of pulmonary embolism was similar as predicted by the Wells score or Pulmonary Embolism Rule–Out Criteria in patients with low and moderate clinical probability.

Conclusion: The results of this study confirm that pulmonary embolism is rarely found in patients admitted to the emergency department with syncope. Althoughpulmonary embolismshould be considered as a differential diagnosis, it does not need to be evaluated in all patients. Otherwise, assessment can lead to false positive results and overtreatment, thereby increasing adverse events and healthcare costs.


Bass AR, Fields KG, Goto R, et al. Clinical decision rules for pulmonary embolism in hospitalized patients: a systematic literature review and meta-analysis. Thromb Haemost 2017; 117: 2176-85.

Kukla P, McIntyre WF, Koracevic G, et al. Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism. Am J Cardiol 2015; 115: 825-30.

Konstantinides S, Geibel A, Olschewski M, et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997; 96: 882-8.

Goncalves ML, Abreu L, Marmelo B, et al. The prognostic value of the clinical presentation with syncope in acute pulmonary thromboembolism. Eur J Heart Fail 2017; 19: 537-8.

Prandoni P, Lensing AW, Prins MH, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med 2016; 375: 1524-31.

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 2018; 36: 551-5.

Elias A, Mallett S, Daoud-Elias M, et al. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open 2016; 6: e010324.

Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163: 1711-7.

Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100: 598-603.

Altınsoy B, Erboy F, Tanrıverdi H, et al. Syncope as a presentation of acute pulmonary embolism. Ther Clin Risk Manag 2016; 12: 1023-8.

Thames MD, Alpert JS, Dalen JE. Syncope in patients with pulmonary embolism. JAMA 1977; 238: 2509-11.

Kumasaka N, Sakuma M, Shirato K. Clinical features, and predictors of in-hospital mortality in patients with acute and chronic pulmonary thromboembolism. Intern Med 2000; 39: 1038-43.

Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-9.

Castelli R, Tarsia P, Tantardini C, et al. Syncope in patients with pulmonary embolism: comparison between patients with syncope as the presenting symptom of pulmonary embolism and patients with pulmonary embolism without syncope. Vasc Med 2003; 8: 257-61.

Prandoni P, Lensing AW, Prins MH, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope. N Engl J Med 2016; 375: 1524-31.

Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients’ probability of pulmonary embolism: increasing the model’s utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83: 416-20.




How to Cite

YORULMAZ, Şükrü, & ÇELİK, İbrahim E. (2022). Pulmonary embolism prevalence in syncope patients brought to the emergency room by ambulance. Kastamonu Medical Journal, 2(3), 81–83. https://doi.org/10.51271/KMJ-0074