<< Syncope: Risk Stratification And Clinical Decision Making


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.

  1. Grossman SA, Babineau M, Burke, L et al. Do outcomes of near syncope parallel syncope? Am J Emerg Med. 2012;30(1):203-206. (Prospective cohort; 244 patients)
  2. Guldner S, Langada V, Popp S, et al. Patients with syncope in a German emergency department: description of patients and processes. Dtsch Arztebl Int. 2012;109(4):58-65. (Retrospective cohort; 440 patients)
  3. Baron-Esquivias G, Martinez-Alday J, Martin A, et al. Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study. Europace. 2010;12(6):869-876. (Prospective observational study; 1419 patients)
  4. * Sarasin FP, Louis-Simonet M, Carballo D, et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med. 2001;111(3):177-184. (Prospective cohort; 650 patients)
  5. McLaren AJ, Lear J, Daniels RG. Collapse in an accident and emergency department. J R Soc Med. 1994;87(3):138-139. (Retrospective cohort; 112 patients)
  6. Sun BC, Emond JA, Camargo CAJ. Characteristics and admission patterns of patients presenting with syncope to U.S. emergency departments, 1992-2000. Acad Emerg Med. 2004;11(10):1029-1034. (Retrospective cohort, database; 6,662,000 patients)
  7. Blanc JJ, L’her C, Touiza A, et al. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J. 2002;23(10):815-820. (Retrospective cohort; 454 patients)
  8. Brignole M, Menozzi C, Bartoletti A, et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J. 2006;27(1):76-82. (Prospective cohort; 541 patients)
  9. Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med. 2002;347(12):878-885. (Retrospective cohort; 727 patients)
  10. Vanbrabant P, Gillet J, Buntinx F, et al. Incidence and outcome of first syncope in primary care: a retrospective cohort study. BMC Fam Pract. 2011;12(1):102. (Retrospective cohort; 2785 patients)
  11. Olde Nordkamp LRA, van Dijk N, Ganzeboom KS, et al. Syncope prevalence in the ED compared to general practice and population: a strong selection process. Am J Emerg Med. 2009;27(3):271-279. (Retrospective cohort; 672 patients)
  12. Kapoor WN. Evaluation and outcome of patients with syncope. Medicine (Baltimore). 1990; 69(3):160-175. (Prospective cohort; 433 patients)
  13. Farwell D, Sulke N. How do we diagnose syncope? J Cardiovasc Electrophysiol. 2002;13(1 Suppl):S9-S13. (Retrospective cohort; 660 patients)
  14. Meyer MD, Handler J. Evaluation of the patient with syncope: an evidence based approach. Emerg Med Clin North Am. 1999;17(1):189-201. (Systematic review)
  15. Sheldon R, Hersi A, Ritchie D, et al. Syncope and structural heart disease: historical criteria for vasovagal syncope and ventricular tachycardia. J Cardiovasc Electrophysiol. 2010; 21(12):1358-1364. (Prospective cohort; 134 patients)
  16. Vanbrabant P, Van Ouytsel V, Knockaert D, et al. Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot study. Acta Clin Belg. 2011;66(2):110-115. (Retrospective cohort; 117 patients)
  17. Maung AA, Kaplan LJ, Schuster KM, et al. Routine or protocol evaluation of trauma patients with suspected syncope is unnecessary. J Trauma. 2011;70(2):428-432. (Retrospective cohort; 302 patients)
  18. Mendu ML, McAvay G, Lampert R, et al. Yield of diagnostic tests in evaluating syncopal episodes in older patients. Arch Intern Med. 2009;169(14):1299-1305. (Retrospective chart review; 2106 patients)
  19. Suzuki T, Matsunaga N, Kohsaka S. Diagnostic patterns in the evaluation of patients hospitalized with syncope. Pacing Clin Electrophysiol. 2006; 29(11):1240-1244. (Retrospective chart review; 267 patients)
  20. Pires LA, Ganji JR, Jarandila R, et al. Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope. Arch Intern Med. 2001;161(15):1889-1895. (Retrospective cohort; 649 patients)
  21. Linzer M, Yang EH, Estes NA, et al. Diagnosing syncope. Part 1: value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med. 1997;126(12):989-996. (Guideline, systematic review)
  22. McCarthy F, De Bhladraithe S, Rice C, et al. Resource utilisation for syncope presenting to an acute hospital emergency department. Ir J Med Sci. 2010;179(4):551-555. (Retrospective cohort; 214 patients)
  23. Casini-Raggi V, Bandinelli G, Lagi A. Vasovagal syncope in emergency room patients: analysis of a metropolitan area registry. Neuroepidemiology. 2002;21(6):287-291. (Retrospective cohort; 1290 patients)
  24. Brignole M, Malasana G, Sherwood RP, et al. Evaluation of patients with “faint” in an American teaching hospital: a dire need for a standardized approach. Pacing Clin Electrophysiol. 2011;34(3):284-290. (Retrospective cohort; 100 patients)
  25. Brignole M, Disertori M, Menozzi C, et al. Management of syncope referred urgently to general hospitals with and without syncope units. Europace. 2003;5(3):293-298. (Retrospective, case control; 553 patients)
  26. Brignole M, Ungar A, Casagranda I, et al. Prospective multicentre systematic guideline-based management of patients referred to the syncope units of general hospitals. Europace. 2010;12(1):109-118. (Prospective cohort, intervention; 745 patients, control 929 patients)
  27. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial - the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J. 2000;21(11):935-940. (Prospective cohort; 195 patients)
  28. Croci F, Brignole M, Alboni P, et al. The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units. Europace. 2002;4(4):351-355. (Prospective cohort; 308 patients)
  29. Moya A, Garcia-Civera R, Croci F, et al. Diagnosis, management, and outcomes of patients with syncope and bundle branch block. Eur Heart J. 2011;32(12):1535-1541. (Guideline)
  30. Sule S, Palaniswamy C, Aronow W, et al. Etiology of syncope in patients hospitalized with syncope and predictors of mortality and readmission for syncope at 17-month follow-up: a prospective study. Am J Ther. 2012. (Prospective cohort; 242 patients)
  31. Kapoor WN, Karpf M, Wieand S, et al. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983;309(4):197-204. (Prospective cohort; 204 patients)
  32. * D’Ascenzo F, Biondi-Zoccai G, Reed M, et al. Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the emergency department with syncope: an international meta-analysis. Int J Cardiol. 2013;167(1)57-62. (Meta-analysis; 11 articles, 43,315 patients)
  33. Martin GJ, Adams SL, Martin HG, et al. Prospective evaluation of syncope. Ann Emerg Med. 1984;13(7):499-504. (Prospective cohort; 170 patients)
  34. Shiyovich A, Munchak I, Zelingher J, et al. Admission for syncope: evaluation, cost and prognosis according to etiology. Isr Med Assoc J. 2008;10(2):104-108. (Retrospective cohort; 376 patients)
  35. * Oh JH, Hanusa BH, Kapoor WN. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope? Arch Intern Med. 1999;159(4):375-380. (Prospective cohort; 497 patients)
  36. Ben-Chetrit E, Flugelman M, Eliakim M. Syncope: a retrospective study of 101 hospitalized patients. Isr J Med Sci. 1985;21(12):950-953. (Retrospective cohort; 101 patients)
  37. * O’Connor J, Meurer LN. What is the diagnostic yield of a standardized sequential clinical evaluation of patients presenting to an emergency department with syncope? J Fam Pract. 2001; 50(12):1020. (Prospective cohort; 650 patients)
  38. van Dijk N, Boer KR, Colman N, et al. High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: the Fainting Assessment study. J Cardiovasc Electrophysiol. 2008;19(1):48-55. (Prospective cohort; 503 patients)
  39. Recchia D, Barzilai B. Echocardiography in the evaluation of patients with syncope. J Gen Intern Med. 1995;10(12):649-655. (Retrospective cohort; 128 patients)
  40. Huff JS, Decker WW, Quinn JV et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49(4):431-444. (Guideline)
  41. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009;30(21):2631-2671. (Systematic review, guideline)
  42. Westby M, David S, Bullock I, et al. Transient loss of consciousness (‘blackouts’) management in adults and young people. London: National Clinical Guideline Centre for Acute and Chronic Conditions. Royal College of Physicians. 2010. (Systematic review, guideline)
  43. Sheldon RS, Morillo CA, Krahn AD, et al. Standardized approaches to the investigation of syncope: Canadian Cardiovascular Society position paper. Can J Cardiol. 2011; 27(2):246-253. (Systematic review, guideline)
  44. Thijs RD, Benditt DG, Mathias CJ, et al. Unconscious confusion--a literature search for definitions of syncope and related disorders. Clin Auton Res. 2005;15(1):35-39. (Systematic review)
  45. Romme JJCM, van Dijk N, Boer KR, et al. Influence of age and gender on the occurrence and presentation of reflex syncope. Clin Auton Res. 2008;18(3):127-133. (Prospective cohort; 503 patients)
  46. Quinn J, McDermott D, Kramer N, et al. Death after emergency department visits for syncope: how common and can it be predicted? Ann Emerg Med. 2008;51(5):585-590. (Prospective cohort; 1418 patients)
  47. Alboni P, Brignole M, Menozzi C, et al. Clinical spectrum of neurally mediated reflex syncopes. Europace. 2004;6(1):55-62. (Prospective cohort; 280 patients)
  48. Colivicchi F, Ammirati F, Santini M. Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J. 2004;25(19):1749-1753. (Retrospective cohort, cross sectional study; 474 patients)
  49. Colivicchi F, Ammirati F, Biffi A, et al. Exercise-related syncope in young competitive athletes without evidence of structural heart disease. Clinical presentation and long-term outcome. Eur Heart J. 2002;23(14):1125-1130. (Prospective cohort; 33 patients)
  50. Atkins D, Hanusa B, Sefcik T, et al. Syncope and orthostatic hypotension. Am J Med. 1991;91(2):179-185. (Prospective cohort; 223 patients)
  51. * Sarasin FP, Louis-Simonet M, Carballo D, et al. Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Am J Emerg Med. 2002;20(6):497-501. (Prospective cohort; 579 patients)
  52. Davidson E, Rotenbeg Z, Fuchs J, et al. Transient ischemic attack-related syncope. Clin Cardiol. 1991;14(2):141-144. (Retrospective cohort study; 37 patients)
  53. Kollar B, Mikes P, Siarnik P, et al. Vasovagal (neurocardiogenic) syncope in the clinical practice. Neuro Endocrinol Lett. 2012;33(1):60-66. (Retrospective cohort; 70 patients)
  54. Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol. 1994;36(2):233-237. (Prospective cohort, observational; 59 patients)
  55. Josephson CB, Rahey S, Sadler RM. Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy. Can J Neurol Sci. 2007;34(2):221-224. (Retrospective cohort; 194 patients)
  56. Brigo F, Nardone R, Bongiovanni LG. Value of tongue biting in the differential diagnosis between epileptic seizures and syncope. Seizure. 2012;21(8):568-572. (Meta-analysis; 173 patients)
  57. Kapoor WN, Fortunato M, Hanusa BH, et al. Psychiatric illnesses in patients with syncope. Am J Med. 1995;99(5):505- 512. (Prospective cohort; 503 patients)
  58. Wiener Z, Shapiro NI, Chiu DT-W, et al. The prevalence of psychiatric disease in emergency department patients with unexplained syncope. Intern Emerg Med. 2013;8(5):427-430. (Prospective cohort; 518 patients)
  59. Wiener Z, Chiu D, Shapiro N, et al. Substance abuse in emergency department patients with unexplained syncope. Intern Emerg Med. December 2013. [Epub ahead of print] (Prospective cohort; 518 patients)
  60. Mitro P, Kirsch P, Valocik G, et al. Clinical history in the diagnosis of the cardiac syncope-the predictive scoring system. Pacing Clin Electrophysiol. 2011;34(11):1480-1485. (Prospective cohort; 200 patients)
  61. Calkins H, Shyr Y, Frumin H, et al. The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope. Am J Med. 1995;98(4):365-373. (Cross-sectional cohort; 80 patients)
  62. Sud S, Klein GJ, Skanes AC, et al. Predicting the cause of syncope from clinical history in patients undergoing prolonged monitoring. Heart Rhythm. 2009;6(2):238-243. (Retrospective cohort; 52 patients)
  63. Alboni P, Brignole M, Menozzi C, et al. Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001;37(7):1921-1928. (Prospective cohort study; 356 patients)
  64. Del Rosso A, Alboni P, Brignole M, et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol. 2005;96(10):1431-1435. (Prospective cohort study; 485 patients)
  65. Berecki-Gisolf J, Sheldon A, Wieling W, et al. Identifying cardiac syncope based on clinical history: a literature-based model tested in four independent datasets. PLoS One. 2013; 8(9). (Derivation from literature; 2388 patients, retrospective validation in 4 datasets; total 5739 patients)
  66. Bartoletti A, Fabiani P, Bagnoli L, et al. Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur Heart J. 2008;29(5):618-624. (Prospective observational cohort; 1114 patients with syncope)
  67. * Sun BC, Hoffman JR, Mower WR, et al. Low diagnostic yield of electrocardiogram testing in younger patients with syncope. Ann Emerg Med. 2008;51(3):240-246. (Prospective cohort; 477 patients)
  68. Gatzoulis KA, Karystinos G, Gialernios T, et al. Correlation of noninvasive electrocardiography with invasive electrophysiology in syncope of unknown origin: implications from a large syncope database. Ann Noninvasive Electrocardiol. 2009;14(2):119-127. (Part retrospective, part prospective cohort; 421 patients)
  69. Da Costa A, Gulian JL, Romeyer-Bouchard C, et al. Clinical predictors of cardiac events in patients with isolated syncope and negative electrophysiologic study. Int J Cardiol. 2006; 109(1):28-33. (Retrospective cohort; 329 patients)
  70. McDermott D, Quinn JV, Murphy CE. Acute myocardial infarction in patients with syncope. CJEM. 2009;11(2):156-160. (Prospective cohort; 1474 patients)
  71. Quinn J, McDermott D. Electrocardiogram findings in emergency department patients with syncope. Acad Emerg Med. 2011;18(7):714-718. (Prospective cohort; 684 patients)
  72. Thiruganasambandamoorthy V, Hess EP, Turko E, et al. Defining abnormal electrocardiography in adult emergency department syncope patients: the Ottawa Electrocardiographic Criteria. CJEM. 2012;14(4):248-258. (Retrospective cohort; 490 patients)
  73. Kapoor WN, Cha R, Peterson JR, et al. Prolonged electrocardiographic monitoring in patients with syncope. Importance of frequent or repetitive ventricular ectopy. Am J Med. 1987;82(1):20-28. (Prospective cohort; 235 patients)
  74. Roos M, Sarkozy A, Brodbeck J, et al. The importance of class-I antiarrhythmic drug test in the evaluation of patients with syncope: unmasking Brugada syndrome. J Cardiovasc Electrophysiol. 2012;23(3):290-295. (Retrospective cohort; 57 patients)
  75. Sarasin FP, Carballo D, Slama S, et al. Usefulness of 24-h Holter monitoring in patients with unexplained syncope and a high likelihood of arrhythmias. Int J Cardiol. 2005;101(2):203-207. (Secondary analysis of prospective cohort; 140 patients)
  76. Ringqvist I, Jonason T, Nilsson G, et al. Diagnostic value of longterm ambulatory ECG in patients with syncope, dizziness or palpitations. Clin Physiol. 1989;9(1):47-55. (Prospective cohort; 63 patients)
  77. Bass EB, Curtiss EI, Arena VC et al. The duration of Holter monitoring in patients with syncope. Is 24 hours enough? Arch Intern Med. 1990;150(5):1073-1078. (Prospective cohort; 95 patients)
  78. Benezet-Mazuecos J, Ibanez B, Rubio JM, et al. Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope. Europace. 2007;9(12):1196-1201. (Prospective cohort; 102 patients)
  79. Sarasin FP, Junod AF, Carballo D, et al. Role of echocardiography in the evaluation of syncope: a prospective study. Heart. 2002;88(4):363-367. (Prospective observational; 650 patients)
  80. Link MS, Kim KM, Homoud MK, et al. Long-term outcome of patients with syncope associated with coronary artery disease and a nondiagnostic electrophysiologic evaluation. Am J Cardiol. 1999;83(9):1334-1337. (Prospective cohort; 155 patients)
  81. Tan MP, Newton JL, Chadwick TJ, et al. The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case-control study. Europace. 2008;10(12):1400-1405. (Case control; 302 patients)
  82. Kerr SRJ, Pearce MS, Brayne C, et al. Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Arch Intern Med. 2006;166(5):515- 520. (Prospective cohort [random sample]; 272 patients)
  83. Paling D, Vilches-Moraga A, Akram Q, et al. Carotid sinus syndrome is common in very elderly patients undergoing tilt table testing and carotid sinus massage because of syncope or unexplained falls. Aging Clin Exp Res. 2011;23(4):304-308. (Prospective cohort; 179 patients)
  84. Humm AM, Mathias CJ. Unexplained syncope--is screening for carotid sinus hypersensitivity indicated in all patients aged > 40 years? J Neurol Neurosurg Psychiatry. 2006;77(11):1267-1270. (Retrospective study; 373 patients)
  85. Grossman SA, Fischer C, Bar JL, et al. The yield of head CT in syncope: a pilot study. Intern Emerg Med. 2007;2(1):46-49. (Prospective cohort; 113 patients)
  86. Goyal N, Donnino MW, Vachhani R, et al. The utility of head computed tomography in the emergency department evaluation of syncope. Intern Emerg Med. 2006;1(2):148-150. (Retrospective chart review; 117 patients)
  87. Giglio P, Bednarczyk EM, Weiss K, et al. Syncope and head CT scans in the emergency department. Emerg Radiol. 2005;12(1-2):44-46. (Retrospective cohort; 128 patients of which 44 had head CT scans)
  88. Dantas FG, Cavalcanti AP, Rodrigues Maciel BD, et al. The role of EEG in patients with syncope. J Clin Neurophysiol. 2012;29(1):55-57. (Retrospective cohort; 1003 patients)
  89. Poliquin-Lasnier L, Moore FGA. EEG in suspected syncope: do EEGs ordered by neurologists give a higher yield? Can J Neurol Sci. 2009;36(6):769-773. (Retrospective cohort; 517 patients)
  90. Abubakr A, Wambacq I. The diagnostic value of EEGs in patients with syncope. Epilepsy Behav. 2005;6(3):433-434. (Retrospective cohort; 1094 patients)
  91. Davis TL, Freemon FR. Electroencephalography should not be routine in the evaluation of syncope in adults. Arch Intern Med. 1990;150(10):2027-2029. (Retrospective cohort study; 73 patients)
  92. Reed MJ, Newby DE, Coull AJ, et al. Diagnostic and prognostic utility of troponin estimation in patients presenting with syncope: a prospective cohort study. Emerg Med J. 2010; 27(4):272-276. (Prospective cohort; 289 patients)
  93. Hing R, Harris R. Relative utility of serum troponin and the OESIL score in syncope. Emerg Med Australas. 2005;17(1):31- 38. (Prospective cohort; 100 patients)
  94. Reed MJ, Mills NL, Weir CJ. Sensitive troponin assay predicts outcome in syncope. Emerg Med J. 2012;29(12):1001- 1003. (Prospective cohort; 338 patients)
  95. Pfister R, Hagemeister J, Esser S, et al. NT-pro-BNP for diagnostic and prognostic evaluation in patients hospitalized for syncope. Int J Cardiol 2012;155(2):268-272. (Prospective cohort; 61 patients)
  96. Pfister R, Diedrichs H, Larbig R et al. NT-pro-BNP for differential diagnosis in patients with syncope. Int J Cardiol. 2009;133(1):51-54. (Prospective cohort; 61 patients)
  97. Reed MJ, Newby DE, Coull AJ, et al. Role of brain natriuretic peptide (BNP) in risk stratification of adult syncope. Emerg Med J. 2007;24(11):769-773. (Prospective cohort; 99 patients)
  98. Zhang Q, Jin H, Qi J, et al. Diagnostic value of serum brain natriuretic peptide in syncope in children and adolescents. Acta Paediatr. 2013;102(5):e210-e214. (Prospective cohort; 62 patients)
  99. Ahmad S, Beckett MW. Value of serum prolactin in the management of syncope. Emerg Med J. 2004; 21(2):e3. (Metaanalysis; 3 articles included)
  100. Goksu E, Oktay C, Kilicaslan, I et al. Seizure or syncope: the diagnostic value of serum creatine kinase and myoglobin levels. Eur J Emerg Med. 2009;16(2):84-86. (Prospective cohort, case-control; 63 patients)
  101. Gabayan GZ, Derose SF, Asch SM, et al. Predictors of short-term (seven-day) cardiac outcomes after emergency department visit for syncope. Am J Cardiol. 2010;105(1):82-86. (Retrospective cohort; 35,330 patients)
  102. Chen LY, Gersh BJ, Hodge DO, et al. Prevalence and clinical outcomes of patients with multiple potential causes of syncope. Mayo Clin Proc. 2003;78(4):414-420. (Retrospective cohort; 987 patients)
  103. Grossman SA, Fischer C, Kancharla A, et al. Can benign etiologies predict benign outcomes in high-risk syncope patients? J Emerg Med. 2011;40(5):592-597. (Prospective cohort; 293 patients)
  104. Grossman SA, Babineau M, Burke L, et al. Applying the Boston syncope criteria to near syncope. J Emerg Med. 2012;43(6):958-963. (Prospective cohort; 244 patients)
  105. Derose SF, Gabayan GZ, Chiu VY, et al. Patterns and preexisting risk factors of 30-day mortality after a primary discharge diagnosis of syncope or near syncope. Acad Emerg Med. 2012;19(5):488-496. (Retrospective cohort; 22,189 patients)
  106. Ungar A, Del Rosso A, Giada F, et al. Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. Eur Heart J. 2010; 31(16):2021-2026. (Prospective cohort; 465 patients)
  107. Sun BC, Derose SF, Liang LJ, et al. Predictors of 30-day serious events in older patients with syncope. Ann Emerg Med. 2009;54(6):769-778. (Retrospective cohort; 2584 patients)
  108. Crane SD. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J. 2002;19(1):23-27. (Retrospective cohort; 210 patients)
  109. Kapoor WN, Hanusa BH. Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope. Am J Med. 1996;100(6):646-655. (Prospective cohort, case-control; 1000 patients)
  110. Eagle KA, Black HR, Cook EF, et al. Evaluation of prognostic classifications for patients with syncope. Am J Med. 1985;79(4):455-460. (Prospective cohort; 176 patients)
  111. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med. 1997;29(4):459-466. (Prospective cohort; derivation 252 patients; validation 374 patients)
  112. Middlekauff HR, Stevenson WG, Stevenson LW, et al. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol. 1993; 21(1):110-116. (Prospective cohort; 491 patients)
  113. Kayayurt K, Akoglu H, Limon O, et al. Comparison of existing syncope rules and newly proposed anatolian syncope rule to predict short-term serious outcomes after syncope in the Turkish population. Int J Emerg Med. 2012;5:17. (Prospective cohort; 231 patients)
  114. Freed LA, Eagle KA, Mahjoub ZA, et al. Gender differences in presentation, management, and cardiac event-free survival in patients with syncope. Am J Cardiol. 1997;80(9):1183- 1187. (Retrospective cohort; 109 patients)
  115. Kapoor W, Snustad D, Peterson J, et al. Syncope in the elderly. Am J Med. 1986;80(3):419-428. (Prospective cohort; 400 patients)
  116. Alshekhlee A, Shen WK, Mackall J, et al. Incidence and mortality rates of syncope in the United States. Am J Med. 2009;122(2):181-188. (Retrospective cross-sectional study; 296,813 patients)
  117. Costantino G, Perego F, Dipaola F, et al. Short- and longterm prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study. J Am Coll Cardiol. 2008;51(3):276-283. (Prospective cohort study; 676 patients)
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  119. Thiruganasambandamoorthy V, Hess EP, Alreesi A, et al. External validation of the San Francisco Syncope Rule in the Canadian setting. Ann Emerg Med. 2010;55(5):464-472. (Retrospective cohort; 505 patients)
  120. Schladenhaufen R, Feilinger S, Pollack M, et al. Application of San Francisco Syncope Rule in elderly ED patients. Am J Emerg Med. 2008;26(7):773-778. (Retrospective cohort; 517 patients)
  121. Birnbaum A, Esses D, Bijur P, et al. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52(2):151-159. (Prospective cohort; 743 patients)
  122. Cosgriff TM, Kelly AM, Kerr D. External validation of the San Francisco Syncope Rule in the Australian context. CJEM. 2007;9(3):157-161. (Prospective cohort; 113 patients)
  123. Sun BC, Mangione CM, Merchant G, et al. External validation of the San Francisco Syncope Rule. Ann Emerg Med. 2007;49(4):420-427. (Prospective cohort; 447 patients)
  124. Quinn J, McDermott D, Stiell I, et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006;47(5):448-454. (Prospective cohort; 791 patients)
  125. Quinn JV, Stiell IG, McDermott DA, et al. The San Francisco Syncope Rule vs physician judgment and decision making. Am J Emerg Med. 2005;23(6):782-786. (Prospective cohort; 684 patients)
  126. Quinn JV, Stiell IG, McDermott DA, et al. Derivation of the San Francisco Syncope Rule to predict patients with shortterm serious outcomes. Ann Emerg Med. 2004;43(2):224-232. (Prospective cohort; 684 patients)
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Publication Information

Suzanne Y. G. Peeters, MD; Amber E. Hoek, MD; Susan M. Mollink, MD; J. Stephen Huff, MD

Publication Date

April 2, 2014

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