The outcome of patients after “collapse”

Objective: There have been few studies examining patients with a triage diagnosis of collapse and none which has determined the outcome of these patients as a group. This study was undertaken to determine the frequency of the triage diagnosis of collapse, the differential diagnosis in these patients, and if any errors in diagnosis occurred. Design: Case notes over a six month period from the 1 October 1991 to the 31 March 1992 were retrospectively studied. Outcome was assessed at six months. Setting: The Emergency Department of the Geelong Hospital, a 450 bed teaching hospital serving a population of 250,000 in a large provincial centre in Victoria. Results: There were 17,588 attendances to the ED during the study period. One hundred and seventy four patients (1%) had a triage diagnosis of collapse, of whom 173 were included in the study. One hundred and seventy patients were followed up at six months. Faint was the commonest diagnosis (28%), and was usually benign. In particular, faint was the commonest diagnosis in patients over 75 years of age. For patients in whom the diagnosis of faint was made, it was correct in 98% of cases. There was a high overall mortality (9%), and a very high mortality in patients over 75 (24%). No patient less than 60 years of age died. Early deaths were generally due to major cerebrovascular accidents. Later deaths were mostly due to either untreated cardiac disease in very elderly or demented patients or metastatic cancer. The high death rate did not reflect misdiagnosis. It reflected the high morbidity and mortality of conditions which present with collapse, particularly in patients over 75 years of age. Misdiagnosis in these patients was uncommon (3%) and was generally related to three diagnostic areas, epilepsy, arrhythmias and gastrointestinal haemorrhage. Conclusion: Patients presenting with a triage diagnosis of collapse form a significant part of the emergency department workload. Faint is the commonest diagnosis and is usually benign. However, many conditions which present with collapse are associated with a high morbidity and mortality, particularly in patients over 75 years of age. Therefore care must be taken to exclude these more serious conditions, particularly epilepsy, arrhythmia and gastrointestinal haemorrhage, before a diagnosis of simple faint is made.