Role of emergency department observation units in the management of patients with unexplained syncope: a critical review and meta-analysis

Abstract

This meta-analysis aimed to establish the role of standardized emergency department (ED) observation protocols in the management of syncopal patients as an alternative to ordinary admission. A systematic electronic literature search was performed to identify randomized controlled trials or observational studies evaluating syncopal patients managed in ED observation units. Data regarding mean length of stay, rate of etiological diagnosis, admission rate, and incidence of short-term serious outcomes were extracted. Six mostly single-center, small sized studies characterized by high heterogeneity, were included. A total of 458 patients were included with a balanced sex distribution (male 50.2%), a mean age of 60.1 years, and a considerable prevalence of heart disease (32.4%). Pooled analysis of the outcomes showed a mean stay of 28.2 hours, an etiological diagnosis rate of 67.3%, an admission rate of 18.5%, and a very low incidence of short-term serious outcomes (2.8%). Due to elevated diagnostic yield and low incidence of short-term adverse events, ED observation units-based management strategy seems ideal for patients with syncope. Nevertheless, further research is needed to identify criteria for selecting patients to be managed with this approach, define evaluation protocols, and confirm the safety of this strategy.

Sex Differences in Patients Hospitalized for Syncope: Experience in University Hospital of Middle-income Country and with a Predominance of Chagasic Etiology

“…Recent meta-analysis of 6 studies including 458 patients, with equal distribution between the sexes, demonstrated a high diagnostic rate in syncope units. This rate was 67.3% with a length of stay of 28.2 h [44]. As a complement, risk scores -with prognostic risk stratification more easily remembered [45] -can assist in medical decision on emergency for admission of patients in the syncope units or their hospitalization.…”

Triage assessment of transitory loss of consciousness in the emergency department—A retrospective observational study

“…First, the retrospective nature of the study exposes it to the possible bias associated with such a study design. Second, the choice of the acute diseases included in the composite outcome of the study was made a priori on the basis of the literature and similar existing studies (Bonzi et al, 2014;Numeroso et al, 2017Numeroso et al, , 2019Numeroso et al, , 2021. Third, the accuracy of nurse triage was not assessed through inter-rater reliability.…”

Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope

“…Patients with syncope, defined as a sudden transient loss of consciousness (TLOC) caused by temporary cerebral hypoperfusion, account for approximately 3% of total emergency department (ED) encounters and 6% of all medical hospitalisations 4. Patients with presyncope, defined as prodromal syncopal symptoms which do not culminate in TLOC, contribute a further 0.5% of ED presentations5 and have a risk of serious adverse outcomes comparable with that of syncope 6.…”