Syncope in the emergency department: comparison of standardized admission criteria with clinical practice
Abstract
Aims Syncope is a major health care problem that accounts for many emergency department (ED) and hospital admissions. This study was conducted to investigate the short-term risk of serious events in patients presenting to the ED with syncope and to compare guideline-based admission criteria with those adopted in clinical practice. Methods and results A single-centre retrospective analysis was performed on ED visits between January and June 2009. We used the ICD-9 code 780.2 for syncope as the primary diagnosis. The prevalence of serious events within 7 days of the index presentation was evaluated. In addition, admissions and discharges were classified as being appropriate or inappropriate based on standardized guideline-based criteria integrated in a new Faint-Algorithm developed at the University of Utah. Two hundred and fifty-four ED visits met the inclusion criteria. One hundred and thirty-six patients were discharged home and the remaining 118 were admitted. The prevalence of serious events in the discharged and admission groups were 5 and 10, respectively, (P= NS). According to the Faint-Algorithm, the number of inappropriate discharges and admissions were 8 out of 136 and 69 out of 118, respectively. Using the Faint-Algorithm, only 57 patients instead of 118 patients should have been admitted resulting in a 52% reduction in admission rate. Furthermore, in the remaining 197 patients who should have been discharged, the prevalence of serious events was not significantly d…
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Decision support algorithms may reduce health service use in the evaluation of syncope.
“Decision support algorithms may reduce health service use in the evaluation of syncope (Figures 1 and 2) (105,111–113), although there are currently insufficient data to advocate the use of specific decision support algorithms for making disposition decisions.”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [105]
The purpose of hospital-based evaluation is to expedite the treatment of identified serious conditions or to continue the diagnostic evaluation in the absence of a presumptive cause of syncope.
“The purpose of hospital-based evaluation is to expedite the treatment of identified serious conditions or to continue the diagnostic evaluation in the absence of a presumptive cause of syncope (105,106).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [105]
Cites
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Self-citationProspective validation of the San Francisco Syncope Rule to predict patients with serious outcomes
Quinn, J., McDermott, D., Stiell, I., Kohn, M., & Wells, G. (2006) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2005.11.019 · Cited by 309 · see citing works
Short- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission
Costantino, G., Perego, F., Dipaola, F., Borella, M., Galli, A., Cantoni, G., Dell’Orto, S., Dassi, S., Filardo, N., Duca, P. G., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.08.059 · Cited by 246 · cited 2× · see citing works
“(7) LBBB or RBBB+left/right axis deviation (8) Long-QT pattern (9) Brugada pattern (10) ARVD pattern (11) WPW pattern 12-lead standard ECG Cardiac-Ischaemic causes (12) Cardiac ischaemia Chest pain and troponin abnormal Cardiovascular and pulmonary structural causes (13) Prolapsing atrial myxoma, tumour (14) Severe ao…”
BackgroundFailure to validate the San Francisco Syncope Rule in an independent emergency department population
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External validation of the San Francisco Syncope Rule
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A risk score to predict arrhythmias in patients with unexplained syncope
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Self-citationShen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.002 · Cited by 155 · see citing works
Self-citationKey challenges in the current management of syncope
Sutton, R., Brignole, M., & Benditt, D. G. (2012) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2012.102 · Cited by 33 · see citing works
Self-citationSwallow syncope: Clinical presentation, diagnostic criteria, and therapeutic options
Girotra, M., Garg, S., Glasser, S., & Dutta, S. (2014) · Saudi Journal of Gastroenterology · doi:10.4103/1319-3767.136932 · Cited by 24 · see citing works
- Authors
- Daccarett, M., Jetter, T. L., Wasmund, S. L., Brignole, M., & Hamdan, M. H.
- Affiliations
- University of Utah (US)
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-07-14
- Volume
- 13
- Issue
- 11
- Pages
- 1632-1638
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2111932916
- Cited by
- 58
- References
- 7
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 3 · 2022: 3 · 2020: 1 · 2019: 4 · 2018: 4 · 2017: 11 · 2016: 2 · 2015: 2 · 2014: 6 · 2013: 6 · 2012: 7
- FWCI
- 6.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- syncope, emergency department, hospital admission criteria, inappropriate discharges, inappropriate admissions, serious adverse events, short-term risk, clinical practice variation
- MeSH terms
- Adult, Aged, Algorithms, Diagnostic Tests, Routine, Emergency Service, Hospital, Europe, Female, Humans, Male, Middle Aged, Patient Discharge, Practice Patterns, Physicians', Retrospective Studies, Syncope, United States, Prevalence, Guidelines as Topic, Risk Assessment
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