Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments
Open accessAbstract
PURPOSE: The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. MATERIALS AND METHODS: This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January- December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. RESULTS: A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). CONCLUSION: Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In this setting, a structured ED protocol can be effective as an alternative to inpatient admission.
“In this setting, a structured ED protocol can be effective as an alternative to inpatient admission (107–110).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [110]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040 · see citing works
Incidence and Prognosis of Syncope
Soteriades, E. S., Evans, J. C., Larson, M. G., Chen, M. H., Chen, L., Benjamin, E. J., & Levy, D. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa012407 · Cited by 1,364 · see citing works
Guidelines on Management (diagnosis and treatment) of syncope ? update 2004
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janousek, J., et al. (2004) · EP Europace · doi:10.1016/j.eupc.2004.08.008 · Cited by 648 · see citing works
Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary.
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janoušek, J., et al. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.09.004 · Cited by 562 · see citing works
AHA/ACCF Scientific Statement on the Evaluation of Syncope
Strickberger, S. A., Benson, D. W., Biaggioni, I., Callans, D. J., Cohen, M. I., Ellenbogen, K. A., Epstein, A. E., Friedman, P. A., Goldberger, J. J., Heidenreich, P. A., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.170274 · Cited by 332 · see citing works
Shen, W. K., Decker, W. W., Smars, P. A., Goyal, D. G., Walker, A. E., Hodge, D. O., Trusty, J. M., Brekke, K. M., Jahangir, A., Brady, P. A., et al. (2004) · Circulation · doi:10.1161/01.cir.0000149236.92822.07 · Cited by 318 · see citing works
Direct medical costs of syncope-related hospitalizations in the United States
Sun, B. C., Emond, J. A., & Camargo, C. A. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.11.013 · Cited by 305 · see citing works
Prospective evaluation and outcome of patients admitted for syncope over a 1 year period
Blanc, J. (2002) · European Heart Journal · doi:10.1053/euhj.2001.2975 · Cited by 303 · see citing works
Guía de práctica clínica para el diagnóstico y manejo del síncope (versión 2009)
Moya‐Mitjans, À., Sutton, R., Ammirati, F., Blanc, J., Brignole, M., Dahm, J. B., Deharo, J., Gajek, J. J., Gjesdal, K., Krahn, A. D., et al. (2009) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(09)73541-8 · Cited by 277 · see citing works
The ROSE (Risk Stratification of Syncope in the Emergency Department) Study
Reed, M. J., Newby, D. E., Coull, A. J., Prescott, R. J., Jacques, K. G., & Gray, A. J. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.09.049 · Cited by 272 · see citing works
Ammirati, F. (2000) · European Heart Journal · doi:10.1053/euhj.1999.1910 · Cited by 205 · see citing works
Brignole, M., Ungar, A., Bartoletti, A., Ponassi, I., Lagi, A., Mussi, C., Ribani, M. A., Tava, G., Disertori, M., Quartieri, F., et al. (2006) · EP Europace · doi:10.1093/europace/eul071 · Cited by 193 · see citing works
The Emergency Department Occupancy Rate: A Simple Measure of Emergency Department Crowding?
McCarthy, M. L., Aronsky, D., Jones, I. D., Miner, J. R., Band, R. A., Baren, J. M., Desmond, J. S., Baumlin, K. M., Ding, R., & Shesser, R. F. (2007) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.09.003 · Cited by 180 · see citing works
Huff, J. S., Decker, W. W., Quinn, J. V., Perron, A. D., Napoli, A. M., Peeters, S., & Jagoda, A. S. (2007) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.02.001 · Cited by 157 · see citing works
Brignole, M., Ungar, A., Casagranda, I., Gulizia, M., Lunati, M., Ammirati, F., Del Rosso, A., Sasdelli, M., Santini, M., Maggi, R., et al. (2010) · Europace · doi:10.1093/europace/eup370 · Cited by 133 · see citing works
Impact of a dedicated syncope and falls facility for older adults on emergency beds
Kenny, R. A. (2002) · Age and Ageing · doi:10.1093/ageing/31.4.272 · Cited by 130 · see citing works
Serrano, L. A., Hess, E. P., Bellolio, M. F., Murad, M. H., Montori, V. M., Erwin, P. J., & Decker, W. W. (2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.05.013 · Cited by 129 · see citing works
Sheldon, R. S., Morillo, C. A., Krahn, A. D., O'Neill, B., Thiruganasambandamoorthy, V., Parkash, R., Talajic, M., Tu, J. V., Seifer, C., Johnstone, D., et al. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2010.11.002 · Cited by 126 · see citing works
Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis*
Thiel, S. W., Asghar, M. F., Micek, S. T., Reichley, R. M., Doherty, J. A., & Kollef, M. H. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e318196206b · Cited by 111 · see citing works
Management of syncope: clinical and economic impact of a Syncope Unit
Ammirati, F., Colaceci, R., Cesario, A., Strano, S., Della Scala, A., Colangelo, I., De Santo, T., Toscano, E., Ricci, R., & Santini, M. (2008) · Europace · doi:10.1093/europace/eun061 · Cited by 73 · see citing works
Elesber, A. A., Decker, W. W., Smars, P. A., Hodge, D. O., & Shen, W.-K. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.07.024 · Cited by 58 · see citing works
Fedorowski, A., Burri, P., Juul‐Möller, S., & Melander, O. (2010) · EP Europace · doi:10.1093/europace/euq168 · Cited by 54 · see citing works
The Prevalence and Cost of the Faint and Fall Problem in the State of Utah
Malasana, G., Brignole, M., Daccarett, M., Sherwood, R. P., & Hamdan, M. H. (2010) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2010.02930.x · Cited by 48 · see citing works
Blanc, J. J., L'Her, C., Gosselin, G., Cornily, J., & Fatemi, M. (2005) · EP Europace · doi:10.1016/j.eupc.2005.03.010 · Cited by 42 · see citing works
(1998) · PubMed · Cited by 31 · see citing works
Predictors of Short-Term (Seven-Day) Cardiac Outcomes After Emergency Department Visit for Syncope
Gabayan, G. Z., Derose, S. F., Asch, S. M., Chiu, V. Y., Glenn, S. C., Mangione, C. M., & Sun, B. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.08.654 · Cited by 30 · see citing works
Management of Syncope in Adults: An Update
Chen, L. Y., Benditt, D. G., & Shen, W.-K. (2008) · Mayo Clinic Proceedings · doi:10.4065/83.11.1280 · Cited by 29 · see citing works
Sclafani, J. J., My, J., Zacher, L. L., & Eckart, R. E. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.205 · Cited by 25 · see citing works
Brignole, M., Malasana, G., Sherwood, R. P., Daccarett, M., Jetter, T. L., & Hamdan, M. H. (2010) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2010.02968.x · Cited by 18 · see citing works
Cost-effectiveness of diagnostic approaches to vasovagal syncope.
Li, Y.-W., Chen, L., Du, J., Yang, Y., & Jin, H. (2010) · PubMed · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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
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) · Circulation · doi:10.1161/cir.0000000000000499 · Cited by 453 · see citing works
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) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 408 · see citing works
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) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
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.2017.03.002 · Cited by 155 · see citing works
Kenny, R. A., Brignole, M., Dan, G., Deharo, J., van Dijk, J. G., Doherty, C. P., Hamdan, M. H., Moya‐Mitjans, À., Parry, S. W., Sutton, R., et al. (2015) · EP Europace · doi:10.1093/europace/euv115 · Cited by 124 · see citing works
Clinical history in management of suspected syncope: A powerful diagnostic tool
Sutton, R., van Dijk, N., & Wieling, W. (2014) · Cardiology Journal · doi:10.5603/cj.2014.0097 · Cited by 39 · see citing works
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.2017.03.005 · Cited by 34 · see citing works
Managing psychogenic pseudosyncope: facts and experiences
Tannemaat, M. R., Thijs, R. D., & Van Dijk, J. G. (2014) · Cardiology Journal · doi:10.5603/cj.a2014.0070 · Cited by 32 · see citing works
Edvardsson, N., Wolff, C., Tsintzos, S., Rieger, G., & Linker, N. J. (2015) · Europace · doi:10.1093/europace/euu412 · Cited by 29 · see citing works
van Wijnen, V. K., Gans, R. O. B., Wieling, W., ter Maaten, J. C., & Harms, M. P. M. (2020) · BMC Emergency Medicine · doi:10.1186/s12873-020-00344-9 · Cited by 25 · see citing works
Heyer, G. L., Harvey, R. A., & Islam, M. P. (2017) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2016.12.018 · Cited by 19 · see citing works
Ghariq, M., van den Hout, W. B., Dekkers, O. M., Bootsma, M., de Groot, B., Groothuis, J. G. J., Harms, M. P. M., Hemels, M. E. W., Kaal, E. C. A., Koomen, E. M., et al. (2023) · BMC Medicine · doi:10.1186/s12916-023-03056-6 · Cited by 13 · see citing works
Khaliq, W., Aboabdo, M., Harris, C. M., Bazerbashi, N., Moughames, E., Jalbout, N. A., Hajjar, K., Beydoun, H. A., Beydoun, M. A., & Eid, S. M. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.01.042 · Cited by 7 · see citing works
Deif, B., Kang, S., Ismail, A., Vanniyasingam, T., Guzmán, J. C., & Morillo, C. A. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.07.003 · Cited by 7 · see citing works
Syncope: risk stratification and clinical decision making.
Peeters, S., Hoek, A. E., Mollink, S. M., & Huff, J. S. (2014) · PubMed · Cited by 7 · see citing works
Golovina, G., Duplyakov, D. V., & Dispensary, S. R. C. (2018) · Kardiologiia · doi:10.18087/cardio.2018.8.10151 · Cited by 4 · see citing works
The value of multidisciplinary team in syncope clinic for the effective diagnosis of complex syncope
Qian, X., Pan, Y., Chen, J., Jiang, Q., Huang, D., & Li, J. (2019) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13703 · Cited by 4 · see citing works
Frontal QRS-T angle predicts cardiac syncope in the emergency department
Hatip, A. Y., Oğuzlar, F. Ç., Yalçın, İ. G., TOPRAK, E., Cesur, E., & Armağan, H. H. (2026) · Heart & Lung · doi:10.1016/j.hrtlng.2026.102906 · Cited by 1 · see citing works
2018 KHRS guideline for the evaluation and management of syncope-Part 1
Park, J., Cha, M.-J., Kim, D. H., Kim, Y. R., Mun, H. S., Bae, E. J., Seo, D. W., Song, M. K., Ahn, J., Yoon, H. D., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.009 · Cited by 1 · see citing works
Self-citationConsidering the Need to Expand the Indications for Wearable Defibrillator Therapy
Milan, D. J., Klein, H., Gimbel, J., Knilans, T. K., Mirro, M. J., & Zirille, F. M. (2019) · Journal of Innovations in Cardiac Rhythm Management · doi:10.19102/icrm.2019.100707 · Cited by 1 · see citing works
2018 KHRS guideline for the evaluation and management of syncope-Part 2
Kim, Y. R., Chun, K. J., Kim, J. S., Mun, H. S., Park, J., Seo, D. W., Song, M. K., Ahn, J. H., Yoon, H. J., Lee, D. I., et al. (2018) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2018.010 · Cited by 1 · see citing works
Self-citationCURRENT METHODS OF OUTPATIENT ELECTROCARDIOGRAPHIC MONITORING. CLINICAL ASPECTS
Pervova, E. V. (2017) · The Clinician · doi:10.17650/1818-8338-2017-11-2-58-73 · Cited by 1 · see citing works
Protocolo de manejo del paciente con síncope en Urgencias
Izco, M. P., Muñoz, D. R., & Gómez, J. L. Z. (2017) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2017.07.005
STRATEGI UNTUK MENGATASI KEPADATAN UNIT GAWAT DARURAT (UGD): TINJAUAN PUSTAKA
Rasimin, R., Syam, Y., Arafat, R., & Majid, S. (2021) · Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing) · doi:10.33023/jikep.v7i1.683
Huang, L., Zhuang, J., Lin, Z., Min, J., Wang, C., Hu, J., & Wu, W. (2024) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2024.07.062
Ghariq, M., van den Hout, W. B., Dekkers, O. M., Bootsma, M., de Groot, B., Groothuis, J. G. J., Harms, M. P. M., Hemels, M. E. W., Kaal, E. C. A., Koomen, E. M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24189103
Ghariq, M., van den Hout, W. B., Dekkers, O. M., Bootsma, M., de Groot, B., Groothuis, J. G. J., Harms, M. P. M., Hemels, M. E. W., Kaal, E. C. A., Koomen, E. M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24189106
Ghariq, M., van den Hout, W. B., Dekkers, O. M., Bootsma, M., de Groot, B., Groothuis, J. G. J., Harms, M. P. M., Hemels, M. E. W., Kaal, E. C. A., Koomen, E. M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.24189100
- Authors
- Shin, T. G., Kim, J. S., Song, H. G., Jo, I. J., Sim, M. S., & Park, S.-J.
- Affiliations
- Samsung Medical Center (KR)
- Executive Board Member of Public Relations, Korean Medical Association, Seoul, Korea.
- Corresponding author
- Kim, June Soo
- Song, Hyoung Gon
- Venue
- Yonsei Medical Journal
- Publisher
- XMLink
- Published
- 2013
- Volume
- 54
- Issue
- 5
- Pages
- 1110
- ISSN
- 0513-5796 (ISSN-L)
- 1976-2437
- PMC
- PMC3743198
- OpenAlex
- W2133895629
- Cited by
- 30
- References
- 30
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 4 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 9 · 2016: 1 · 2015: 2 · 2014: 3
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Yonsei Medical Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Samsung Medical Center (CRS-109-35-2)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- syncope evaluation, emergency department protocol, risk stratification, hospitalization reduction, health care costs, length of hospital stay, standardization of care
- MeSH terms
- Adult, Aged, Costs and Cost Analysis, Crowding, Emergency Medical Services, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Syncope, Observation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
