Approach to syncope in the emergency department

Abstract

Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge.

The Dilemma of Falls in Older Persons: Never Forget to Investigate the Syncope

“…The distinction between an accidental fall from a syncope remains an area of great uncertainty, in particular in older persons [1,[3][4][5]. Despite the well-codified management of syncope in the ED or during a short observation period [1,[13][14][15][16][17][18], the research on falls is limited in quality and quantity [22]. The coexistence of the two conditions is often missed or not adequately handled.…”

“…The management of syncope and falls is well standardized in the acute phase [10,[13][14][15][16]]. In the ED, the discrimination between syncopes and accidental falls and between high-or low-risk syncopes is supported by several diagnostic tools [13][14][15]17,18].…”

“…In the ED, the discrimination between syncopes and accidental falls and between high-or low-risk syncopes is supported by several diagnostic tools [13][14][15]17,18]. However, even considering that syncope represents a major contributor to a fall [16], when a patient is admitted to the ED for trauma, the attention is often misled by the urgency of the trauma itself, in particular when there is a fracture or a major injury. In addition, during the first evaluation, it is often cumbersome to distinguish between a syncope complicated by a trauma or an accidental fall, as it occurs in older patients, particularly those with cognitive impairment or in the absence of witnesses.…”

Role of Biomarkers in the Prediction of Serious Adverse Events after Syncope in Prehospital Assessment: A Multi-Center Observational Study

“…Values expressed as total number (fraction) and medians [25th percentile-75th percentile] as appropriate. 2 The p-values were calculated with Mann-Whitney U-test. 3 For the calculation of the p-value with Chi-square test, the rhythms have been regrouped into two sets, one sinus rhythm, sinus tachycardia and bradycardia, and another set with atrial fibrillation, atrioventricular block, and pacemaker pace.…”

“…Syncope is defined as nontraumatic, transient loss of consciousness due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and complete spontaneous recovery. Syncope itself represents a major challenge for both prehospital emergency medical services (EMS) and emergency department (ED) and accounts for 1%-3% of all ED visits [1][2][3].…”