Management of patients with syncope referred urgently to general hospitals

Disertori, Marcello; Brignole, Michele; Menozzi, Carlo; Raviele, Antonio; Rizzon, Paolo; Santini, Massimo; Proclemer, Alessandro; Tomasi, Corrado; Rossillo, Antonio; Taddei, Filippo; Scivales, A.; Migliorini, Roberta; Santo, Tiziana De

doi:10.1016/s1099-5129(03)00049-7

Cited by 130 publications

(67 citation statements)

References 13 publications

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“…Recent studies from Europe report that 0.9 to 1.2 % of the visits to community-based emergency departments are due to syncope [3,9,17,42,51]. The remarkably consistent fraction of about 1 % in emergency departments in Europe is lower than the 3 % from an older study by Day et al that is often quoted for the frequency of syncope in emergency departments in the USA [11,15,20].…”

Section: ■ Syncope In Emergency Departmentsmentioning

confidence: 98%

Epidemiology of reflex syncope

Colman

Nahm

Ganzeboom³

et al. 2004

Clin Auton Res

234

159

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Section: ■ Syncope In Emergency Departmentsmentioning

confidence: 98%

Epidemiology of reflex syncope

Colman

Nahm

Ganzeboom³

et al. 2004

Clin Auton Res

234

159

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“…Several diagnostic protocols, pathways, and guidelines have been proposed to streamline the evaluation of syncope in both inpatient and outpatient settings. 2,[12][13][14][16][17][18][36][37][38] Despite these efforts, there is no uniform strategy. Clinical evidence for effective triage of patients in the emergency department who have syncope is limited.…”

Section: Syncope Unit Designmentioning

confidence: 99%

Syncope Evaluation in the Emergency Department Study (SEEDS)

Shen¹,

Decker²,

Smars³

et al. 2004

Circulation

276

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Background-The primary aim and central hypothesis of the study are that a designated syncope unit in the emergency department improves diagnostic yield and reduces hospital admission for patients with syncope who are at intermediate risk for an adverse cardiovascular outcome. Methods and Results-In this prospective, randomized, single-center study, patients were randomly allocated to 2 treatment arms: syncope unit evaluation and standard care. The 2 groups were compared with 2 test for independence of categorical variables. Wilcoxon rank sum test was used for continuous variables. Survival was estimated with the Kaplan-Meier method. One hundred three consecutive patients (53 women; mean age 64Ϯ17 years) entered the study. Fifty-one patients were randomized to the syncope unit. For the syncope unit and standard care patients, the presumptive diagnosis was established in 34 (67%) and 5 (10%) patients (PϽ0.001), respectively, hospital admission was required for 22 (43%) and 51 (98%) patients (PϽ0.001), and total patient-hospital days were reduced from 140 to 64. Actuarial survival was 97% and 90% (Pϭ0.30), and survival free from recurrent syncope was 88% and 89% (Pϭ0.72) at 2 years for the syncope unit and standard care groups, respectively. Conclusions-The novel syncope unit designed for this study significantly improved diagnostic yield in the emergency department and reduced hospital admission and total length of hospital stay without affecting recurrent syncope and all-cause mortality among intermediate-risk patients. Observations from the present study provide benchmark data for improving patient care and effectively utilizing healthcare resources.

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“…4,5,[8][9][10][11] Only 29% of attendances were admitted, fewer than rates of 46-76% in published series. 4,9,[10][11][12] This may reflect the presence of dedicated TLoC-specific educational content provided in the ED to embed key principles of diagnosis and onward referral pathways for both syncope and epilepsy. The presence of an adjacent established syncope service is likely to result in a trickle-down effect regarding TLoC awareness.…”

Section: Discussionmentioning

confidence: 99%

A survey of the management of transient loss of consciousness in the emergency department

Matthews¹,

Lawson²,

Parry³

et al. 2014

J R Coll Physicians Edinb

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Background: Transient loss of consciousness (TLoC) is a common presentation to the emergency department (ED). We sought to evaluate current practice in the management of patients with TLoC presenting to a large, city centre ED, against national standards. Methods: The ED admissions database was searched to identify all patients attending with TLoC during October 2012. The clinical record of the attendance was reviewed to determine if the initial assessment met national standards. Results: Ninety-one patients had a primary presentation with TLoC, representing 0.95% of ED attendances. Documentation of before/during/after the clinical event and clinical examination were done well. Notable aspects done less well included lying and standing blood pressure and recording of driving status. No patient was discharged from the ED with a copy of their 12-lead electrocardiogram (ECG). Sixty-five patients (71%) were discharged from the ED, with follow-up arranged for 11 (16%). Additional follow-up would have been appropriate in a further 15 cases (28%). Conclusion: Several aspects of the initial assessment of TLoC were done well. Areas for improvement include driving status documentation and advice, recording of postural blood pressures and ECG provision on discharge.

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Management of patients with syncope referred urgently to general hospitals

Abstract: Great inter-hospital and inter-department heterogeneity in the incidence and management of syncope was observed in general hospitals. As a consequence, we were unable to describe a uniform strategy for the management of syncope in everyday practice.

Cited by 130 publications

References 13 publications

Epidemiology of reflex syncope

Epidemiology of reflex syncope

Syncope Evaluation in the Emergency Department Study (SEEDS)

A survey of the management of transient loss of consciousness in the emergency department

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