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--In this study, PE was diagnosed in ~17% of patients hospitalized for syncope (though this represents only ~4%% of patients presenting to the ED with syncope).
--Patients with PE were more likely to have tachypnea, tachycardia, relative hypotension, signs of DVT, and active cancer -- take a good history and do a good physical exam!
--Consider risk stratifying (Wells/Geneva) and/or performing a D-dimer (i.e "rule out" PE) on your syncope patients, particularly when no alternative diagnosis is apparent.
Additional Information
--The 17.3% prevalence of PE is in admitted patients only (in Italy). Again, 3.8% of patients presenting with syncope had PE diagnosed (though the study was not designed to study the prevalence of PE in patients presenting to the ED with syncope).
--Think about this! They only admitted 27.7% of patients with syncope!!! This suggests they only admitted sick patients with significant comorbidities.
--The vast majority of patients were ruled out by history, physical and ancillary testing and sent home (72.3%).
--Think about PE in syncope patients and do a reasonable work up (i.e. not all hospitalized PE patients need a CTA or V/Q)
References
Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. Prandoni P, Lensing AW, et al. PESIT Investigators.. N Engl J Med. 2016 Oct 20;375(16):1524-1531