Abstract 2144: Triage and Evacuation of Young Patients with Syncope in a Combat Theater of Operations
Introduction: The features of young patients presenting with syncope have typically been underreported. It is a tenet of the military to treat using the appropriate assets as far forward as possible, with rapid evacuation as clinically indicated.
Methods: Retrospective review using the U.S. Department of Defense Military Health System’s Theater Medical Data Store and Joint Medical Workstation, we identified patients evaluated for complaint of syncope from January 2005 to October 2007 in support of conflict resolution in Iraq and Afghanistan while deployed to a combat zone.
Results: We identified 848 patients (75.8% male, age 30.7±10.1 years) with syncope. The majority (n=685, 80.8%) were under the age of 40 years. A prior syncopal event was reported in 31.4% of those 685 (80.8%) patients <40 years, with a median number of prior events of 3 (IQR [1, 10]) and a first occurrence a median of 3 months (IQR [6 days, 2 years]) prior to initial presentation for care within the combat zone. The use of psychotropics in the young was no different than older patients (5.8% vs. 4.9%, p=0.78), but the use of metabolic supplements was nearly 4-fold higher in the younger patient (8.6% vs. 2.5%, p=0.01). The diagnostic yield of the ECG was 2.0% (to include Brugada in one case and LQTS in 2 cases), with frequent abnormal but non-causative findings (11.3%). In those <40 years, there were no head CTs or transthoracic echocardiograms that identified a cause of syncope. There was intra-theater referral for care of 24.5%; and no difference in aeromedical evacuation out of theater between those <40 years and those >40 years (10.8% vs. 8.6%, p=0.08). Patients with a prior episode of syncope were significantly more likely to undergo medical evacuation outside of the combat zone (16.0% vs. 7.7%, p<0.01).
Discussion: In an environment where evacuation for definitive diagnosis of syncope may be more hazardous than the illness itself, we found that one-quarter of patients underwent escalation of care requiring medical evacuation. The evacuation of those <40 years to facilities with advanced battlefield imaging did not add meaningful diagnostic information.