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Aging Clinical and Experimental Research

, Volume 26, Issue 1, pp 33–37 | Cite as

Clinical aspects and diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls

  • M. Rafanelli
  • E. Ruffolo
  • V. M. Chisciotti
  • M. A. Brunetti
  • A. Ceccofiglio
  • F. Tesi
  • A. Morrione
  • N. Marchionni
  • A. Ungar
Original Article

Abstract

Objective

To evaluate the diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls compared to those with a syncope etiologically unexplained after initial evaluation.

Methods

It is an observational study, comparing 298 patients with unexplained fall with 989 patients with unexplained syncope. Each patient underwent supine and upright blood pressure measurement, tilt testing (TT) and carotid sinus massage (CSM).

Results

Patients with unexplained falls were older (75.3 ± 11.1 vs. 63.2 ± 19.2 years, p < 0.001), were more frequently hypertensive (66.1 vs. 47.2 %, p < 0.001) and more frequently prescribed antihypertensive drugs (62.4 vs. 48.7 %, p < 0.001) or benzodiazepines (15.7 vs. 10.6 %, p = 0.01), and in a greater proportion they experienced major traumatic injuries (77.5 vs. 29.6 %, p < 0.001) as a consequence of falls. The TT was less frequently positive in patients with unexplained falls (36 vs. 51.3 %, p < 0.001), whereas a Carotid Sinus Syndrome as suggested by CSM had a similar prevalence in the two groups (14.3 vs. 10.5 %, p = 0.074). Overall, either TT or CSM were positive in 61 % of patients with unexplained falls, and in 64 % of those with syncope (p = 0.346). After matching by age 298 patients with falls (75.3 ± 11.1 years) and 298 patients with unexplained syncope (75.4 ± 11.1 years), we found that the positivity prevalence of TT and CSM were similar in the two groups.

Conclusions

The positivity prevalence of TT and CSM in patients with unexplained falls compared to patients with unexplained syncope is similar. Given its high diagnostic relevance, the neuroautonomic evaluation should be routinely performed in older patients with unexplained falls.

Keywords

Unexplained falls Syncope Neuroautonomic evaluation 

Notes

Acknowledgments

This is an analysis of data collected by the Syncope Unit of the Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence. The analyses described here are only the responsibility of the authors and make no mention of trade names, commercial products or organizations.

Conflict of interest

There are no financial or other relationships with industry that might lead to conflict of interest.

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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • M. Rafanelli
    • 1
  • E. Ruffolo
    • 1
  • V. M. Chisciotti
    • 1
  • M. A. Brunetti
    • 1
  • A. Ceccofiglio
    • 1
  • F. Tesi
    • 1
  • A. Morrione
    • 1
  • N. Marchionni
    • 1
  • A. Ungar
    • 1
  1. 1.Syncope Unit, Division of Geriatric Cardiology and MedicineUniversity of Florence and Azienda Ospedaliero-Universitaria CareggiFlorenceItaly

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