Prevalence of pulmonary embolism in patients with isolated syncope in the emergency department: the PEEPS multicenter prospective cohort study

Introduction: The prevalence of pulmonary embolism (PE) in patients that present to the Emergency Department (ED) with isolated syncope is unclear. Conflicting results were recently reported with a prevalence ranging from less than 1% to up to 17%. However, these studies included patients that may also have had other symptoms suggestive of PE (chest pain or dyspnea), or patients that had no systematic assessment for the presence of PE. Since a low prevalence ( Aims: to evaluate the prevalence of PE in ED patients with isolated syncope. Methods: Multicenter prospective cohort study in seven EDs in France. Adult patients who presented to the ED with syncope (transient loss of consciousness) were included. Patients with chest pain or dyspnea were excluded. Included patients underwent formal work-up for PE, including D-dimer testing and further imaging if positive. Cases of PE were adjudicated by two independent expert radiologists with the review of imaging studies. Results: 411 patients were recruited and tested with D-dimer, in whom 137 (33%) underwent a computed tomographic pulmonary angiogram or a ventilation-perfusion scan. A PE was confirmed in nine patients (prevalence of 2.2%, 95% confidence interval 1.1% to 4.3%), including one sub-segmental PE. Conclusion: In our sample of patients with isolated syncope, the prevalence of PE was 2.2%. This value is not sufficiently low to negate the requirement for a formal work up in the ED, even in the absence of chest pain or dyspnea.