Around 1-3 percent of visits to the emergency room are due to fainting. While most cases are not serious, some could be a symptom of a potentially life-threatening condition like arrhythmia, or heart rhythm disturbance, but there is no simple way for the emergency doctor to screen for it. Now, a new, nine-question screening tool promises to change this.

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A new tool could help doctors determine whether a case of fainting may be a sign of an underlying condition.

The screening tool is the work of researchers at the Ottawa Hospital and the University of Ottawa in Canada, and a study of it is published in the Canadian Medical Association Journal.

Lead author Venkatesh Thiruganasambandamoorthy, an assistant professor at the University of Ottawa and an emergency physician and scientist at The Ottawa Hospital, says:

“Fainting is a big problem. The way fainting patients are examined in emergency rooms varies greatly between physicians and hospitals.”

Fainting is not uncommon; 35-40 percent of people will faint at least once in their lives. However, for around 1 in 10 people who visit the emergency room because they have fainted, the event could be a symptom of a serious underlying health problem, such as irregular heartbeat.

The researchers note in their study paper that 7-23 percent of patients who attend the emergency room because they fainted will experience a serious adverse event within 7-30 days, with about half being evident only after they have left the emergency room – either while admitted in the hospital or after they have gone home.

The new screening tool comprises a simple list of nine questions to help the emergency doctor predict the risk of patients experiencing adverse events within a month of fainting. These include irregular heartbeat, heart attacks, and even death.

If the screening tool predicts the risk of an impending adverse event is high, then the doctor would proceed with a thorough evaluation in the hospital before sending the patient home.

For the study – thought to be the largest of its kind in the world – the team observed 4,030 patients visiting six emergency rooms in Canada for fainting. A total of 147 of patients experienced a serious event in the 30 days following their discharge.

These adverse events included: death, heart attack, irregular heartbeat, structural heart disease, pulmonary embolism (blood clot), serious hemorrhage, and procedural interventions.

After following up the patients and analyzing their emergency department clinical records, the team found 43 candidate predictors of the likelihood of adverse events occurring in the 30 days following discharge.

From the 43 predictors, the researchers developed nine factors suitable for plugging into a screening tool. Added together, these give the patient’s risk of an adverse event in the next 30 days as ranging from very low to very high. The factors include:

  • The doctor’s diagnosis of the cause of fainting
  • Evidence of signs of common and harmless causes of fainting such as: being in a crowded, warm place; prolonged standing; feelings of intense fear, emotion or pain
  • History of heart disease
  • Abnormal readings on electrocardiogram (ECG)
  • High levels of a heart muscle protein called troponin.

Another potential benefit of the tool is identifying the majority of patients who are admitted to the hospital for fainting who do not need to be there, says Prof. Thiruganasambandamoorthy. These patients can spend 4-7 hours in the emergency room before the discharge decision is made.

“If our tool can discharge low-risk patients quickly and safely,” he explains, “then I think we can reduce emergency room wait times and open up those resources to other patients.”

A study funded by the Canadian Arrhythmia Network is already validating the screening tool in emergency rooms across Canada. When this is finished, Prof. Thiruganasambandamoorthy wants to turn the tool into an app and also make it available online.

“We hope that this screening tool will make the process more consistent and improve the detection of serious conditions related to fainting.”

Prof. Venkatesh Thiruganasambandamoorthy

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