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Syncope is the transient loss of consciousness and postural tone, with spontaneous recovery. It accounts for approximately 1% of all emergency department visits and $5.6 billion in healthcare costs annually. In a very small subset of patients, syncope may be a warning sign for serious outcomes or death, but identifying these patients is challenging, as the emergency clinician must distinguish between life-threatening causes and the more common, benign etiologies. Low-yield and expensive testing is often performed, even for benign presentations. Much research on syncope is observational, and clinical decision rules frequently perform poorly in validation studies. This issue reviews the clinical and diagnostic findings that are useful for safely and efficiently identifying patients presenting to the emergency department with syncope.
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Following are the most informative references cited in this paper, as determined by the authors.
5. * Brignole M, Moya A, de Lange FJ, et al. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883-1948. (Guidelines) DOI:10.1093/eurheartj/ehy037
22. * D’Ascenzo F, Biondi-Zoccai G, Reed MJ, 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; 43,315 patients) DOI: 10.1016/j.ijcard.2011.11.083
49. * Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope. J Am Coll Cardiol. 2017;70(5):e39-e110. (Guidelines) DOI: 10.1161/CIR.0000000000000499
97. * Thiruganasambandamoorthy V, Sivilotti MLA, Le Sage N, et al. Multicenter emergency department validation of the Canadian Syncope Risk Score. JAMA Internal Medicine. 2020;180(5):737. (Prospective multicenter cohort study; 3819 patients) DOI: 10.1001/jamainternmed.2020.0288
98. * Probst MA, Gibson T, Weiss RE, et al. Risk stratification of older adults who present to the emergency department with syncope: the FAINT Score. Ann Emerg Med. 2020;75(2):147-158. (Prospective observational; 3177 patients) DOI: 10.1016/j.annemergmed.2019.08.429
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Keywords: syncope, TLOC, electrocardiogram, ECG, vasovagal, hypotension, orthostatic, cardiac, seizure, dysrhythmia, palpitation, heart failure, Brugada, CSRS, Canadian syncope risk score, EGSYS
James Morris, MD, MPH, FACEP
Deborah Diercks, MD, MS, FACEP, FACC; Marc A. Probst, MD, MS, FACEP
June 1, 2021
June 1, 2024   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
Price: $59
+4 Credits!
James Morris, MD, MPH, FACEP
Deborah Diercks, MD, MS, FACEP, FACC; Marc A. Probst, MD, MS, FACEP
June 1, 2021
June 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
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