Outcomes in syncope research: a systematic review and critical appraisal

Abstract

Syncope is the common clinical manifestation of different diseases, and this makes it difficult to define what outcomes should be considered in prognostic studies. The aim of this study is to critically analyze the outcomes considered in syncope studies through systematic review and expert consensus. We performed a systematic review of the literature to identify prospective studies enrolling consecutive patients presenting to the Emergency Department with syncope, with data on the characteristics and incidence of short-term outcomes. Then, the strengths and weaknesses of each outcome were discussed by international syncope experts to provide practical advice to improve future selection and assessment. 31 studies met our inclusion criteria. There is a high heterogeneity in both outcome choice and incidence between the included studies. The most commonly considered 7-day outcomes are mortality, dysrhythmias, myocardial infarction, stroke, and rehospitalisation. The most commonly considered 30-day outcomes are mortality, haemorrhage requiring blood transfusion, dysrhythmias, myocardial infarction, pacemaker or implantable defibrillator implantation, stroke, pulmonary embolism, and syncope relapse. We present a critical analysis of the pros and cons of the commonly considered outcomes, and provide possible solutions to improve their choice in ED syncope studies. We also support global initiatives to promote the standardization of patient management and data collection.

Personalized risk stratification through attribute matching for clinical decision making in clinical conditions with aspecific symptoms: The example of syncope

“…In this paper, to assess the potential value of AM and to compare it to multivariate logistic regression we used syncope as a paradigm of those conditions, such as chest pain and shortness of breath, in which the creation of accurate CDTs is particularly challenging. If the condition under consideration is the manifestation of many possible underlying diseases, CDTs are unlikely to accurately identify all the different adverse events related to the possible etiologies [25]. In syncope, CDTs are usually designed to identify multiple diagnoses (i.e.…”

Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis

“…Knowledge of the outcomes of syncope patients may prove useful for improving the management of these patients [6]. Indeed, knowing the type and timing of short-term adverse events is essential for deciding how long and in which setting we should observe patients [7].…”

“…Knowledge of the incidence and time frames of short-term outcomes after syncope is essential for informing effective management strategies and for supporting ED physicians in their decisions to discharge, admit or monitor patients [6]. Indeed, knowing the type and timing of short-term adverse events is essential in order to decide how long and in which setting we should observe patients [7].…”

Prognosis of Syncope With Head Injury: a Tertiary Center Perspective

“…Less is known of the importance of syncope in the prognosis of the patients with traumatic head injury. The long-term prognosis in head trauma patients may be related not only to the severity of head injury but also to the underlying condition, which predisposes to trauma such as alcoholism, drug addiction, or concomitant chronic diseases (16)(17)(18)(19)(20). The aim of this study was to assess whether syncope as a cause of head trauma affects short-and long-term prognosis in patients presenting with head injury.…”