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Management of syncope referred urgently to general hospitals with and without syncope units
Open accessAbstract
OBJECTIVE: We tested the hypothesis that management of patients with syncope admitted urgently to a general hospital may be influenced by the presence of an in-hospital structured syncope unit. BACKGROUND: The management of syncope is not standardized. Methods We compared six hospitals equipped with a syncope unit organized inside the department of cardiology with six matched hospitals without such facilities. The study enroled all consecutive patients referred to the emergency room from 5 November 2001 to 7 December 2001 who were affected by transient loss of consciousness as their principal symptom. RESULTS: There were 279 patients in the syncope unit hospitals and 274 in the control hospitals. In the study group, 30 (11%) patients were referred to the syncope unit for evaluation. In the study group, 12% fewer patients were hospitalized (43 vs 49%, not significant) and 8% fewer tests were performed (3.3+/-2.2 vs 3.6+/-2.2 per patient, not significant). In particular, the study group patients underwent fewer basic laboratory tests (75 vs 86%, P=0.002), fewer brain-imaging examinations (17 vs 24%, P=0.05), fewer echocardiograms (11 vs 16%, P=0.04), more carotid sinus massage (13 vs 8%, P=0.03) and more tilt testing (8 vs 1%, P=0.000). In the study group, there was a +56% rate of final diagnosis of neurally mediated syncope (56 vs 36%, P=0.000). CONCLUSION: Although only a minority of patients admitted as an emergency are referred to the syncope unit, overall management is substantially affected. It is speculated that the use of a standardized approach, such as that typically adopted in the syncope unit, is able to influence overall practice in the hospital.
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“Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates (114–119).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [116]
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“While results have generally been positive in uncontrolled trials and short-term controlled trials, those of long-term, placebo-controlled prospective trials have been less encouraging.”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [116]
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Moya‐Mitjans, À., & Alonso‐Martín, C. (2008) · Revista Española de Cardiología · doi:10.1157/13114951 · Cited by 5
Numeroso, F., Mossini, G., Lippi, G., & Cervellin, G. (2017) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2017.1362146 · Cited by 4
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O’Dwyer, C., & Kenny, R. A. (2010) · European Geriatric Medicine · doi:10.1016/j.eurger.2010.01.012 · Cited by 4
Brandes, A., & Bethge, K.-P. (2008) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-008-0010-9 · Cited by 5
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The Role of the Syncope Management Unit
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Role of Syncope Management Units
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Self-citationSyncope Burden: Economic Impact of Syncope on Health-Care Resources and Personal Well-Being
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Diagnosis and Management of Vasovagal Syncope in the Elderly
Occhetta, E., & Bortnik, M. (2006) · Aging Health · doi:10.2217/1745509x.2.5.809
Metadata
- Authors
- Brignole, M.
- Affiliations
- Presidio Ospedaliero (IT)
- Corresponding author
- Brignole, M
- ORCID
- Brignole, M
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-07
- Volume
- 5
- Issue
- 3
- Pages
- 293-298
- ISSN
- 1099-5129 (ISSN-L)
- OpenAlex
- W2152746692
- Cited by
- 118
- References
- 11
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 6 · 2016: 3 · 2015: 10 · 2014: 10 · 2013: 10 · 2012: 4
- FWCI
- 5.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- syncope, syncope unit, emergency department management, neurally mediated syncope, diagnostic testing, carotid sinus massage, tilt table test, hospital organization, standardization of care
- MeSH terms
- Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospital Units, Hospitals, General, Humans, Male, Middle Aged, Practice Patterns, Physicians', Referral and Consultation, Registries, Syncope
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