How to simplify the implementation of Syncope ESC Guidelines in the Emergency Department and get on the road to achieve "zero inappropriate admissions"

Numeroso, Filippo; Casagranda, Ivo

doi:10.23736/s0026-4806.21.07580-7

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…The flowchart can be modified as shown in Figure 1. Compared to previous studies, [3,10] the following aspects become more relevant: i) the need not to directly discharge from ED with evidence of acute diseases underlying syncope or risk factors for cardiac syncope (see Table 2, showing diagnostic findings and suggestive features for cardiac syncope); these patients should be admitted, in the case of severe acute principal diseases (such as acute cardiovascular diseases or other conditions needing hospitalization per se) or major criteria for cardiac syncope, for diagnostic or therapeutic purposes, or be managed in the emergency department observation unit (EDOU), in the case of non-serious acute condition with pain or fluid loss (eliciting hypotensive syncope) or minor criteria for cardiac syncope; ii) the importance of stratifying the prognosis of syncope based on the frequency and severity of episodes (the "consequential risk"), not just the presence, suspected or proven, of an underlying cardiovascular disease (the "causal risk").…”

Section: Ed Risk Stratification Flow-chartmentioning

confidence: 77%

Improving the approach to non-cardiac syncope in the emergency department observation unit

Numeroso¹,

Casagranda²

2023

World Journal of Emergency Medicine

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Section: Ed Risk Stratification Flow-chartmentioning

confidence: 77%

Improving the approach to non-cardiac syncope in the emergency department observation unit

Numeroso¹,

Casagranda²

2023

World Journal of Emergency Medicine

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A framework to simplify paediatric syncope diagnosis

et al. 2023

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This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic–clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities. Conclusions: In adults, the application of the ESC guidelines reduced the number of absent diagnoses and costs; we hope this also holds for children. What is Known:• Syncope and its mimics are very common in childhood, as they are at other ages.• Syncope and its mimics provide considerable diagnostic challenges. What is New:• Application of the hierarchic framework of transient loss of consciousness (TLOC) simplifies diagnosis.• The framework stresses history-taking to diagnose common conditions while keeping an eye on cardiac danger signs.

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Co-designing and piloting educational materials with patients and healthcare providers for syncope in the emergency department

et al. 2023

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How to simplify the implementation of Syncope ESC Guidelines in the Emergency Department and get on the road to achieve "zero inappropriate admissions"

Cited by 5 publications

References 20 publications

Improving the approach to non-cardiac syncope in the emergency department observation unit

Improving the approach to non-cardiac syncope in the emergency department observation unit

A framework to simplify paediatric syncope diagnosis

Co-designing and piloting educational materials with patients and healthcare providers for syncope in the emergency department

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