Incidence and Outcomes of Adult Syncope Presentations to Emergency Medical Services

Abstract

Objective: The objectives of this systematic review were to evaluate the incidence, patient demographics and associated outcomes of adult syncope presentations to emergency medical services (EMS) within current literature.
 Methods: Inclusion criteria were contact with an EMS, a provisional diagnosis of syncope and epidemiological data regarding EMS contact with these patients. Exclusion criteria were all non-primary studies, patients given an alternative provisional diagnosis or who received life supporting interventions, studies that examined only presyncope presentations or were limited to paediatric patients, or that examined syncope within highly specific non-generalisable settings. Databases were searched on April 5th, 2022, and included Emcare, AMED, Medline, and CINAHL Plus. Quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tool. Data were manually extracted and collated with results synthesised using descriptive statistics and a narrative synthesis.
 Results: 12 studies were included in this review. Studies were primarily completed in Europe or the USA, and sample sizes ranged from 500 to 16 million. Most studies were rated as good to fair in quality. No studies specifically looked at the incidence or outcomes of syncope presentations to EMS. The reported incidence of syncope ranged between 0.09% and 24%.
 Discussion: Most studies were generalised epidemiological studies looking at EMS presentations. There were no studies that specifically looked at the incidence and outcomes of syncope presentations to EMS together. Instead, they were either large scale epidemiological studies that lack detailed analysis or had small samples focusing only on certain patient characteristics or presentations. An improved understanding of the epidemiological features of syncope presentations within the prehospital setting and their associated outcomes are of critical importance for the determination of risk stratification that can help guide clinical decision making by EMS.