Analysis of Temporal and Causal Relationship Between Syncope and 30-Day Events in a Cohort of Emergency Department Patients to Identify the True Rate of Short-term Outcomes

Publication date: Available online 3 September 2018

Source: The Journal of Emergency Medicine

Author(s): Filippo Numeroso, Gianluigi Mossini, Giuseppe Lippi, Gianfranco Cervellin

Abstract

Background

There are a limited number of studies on the short-term prognosis of syncopal patients, and those available are heterogeneous and often have considered events without a clear relationship with the syncopal episode as serious outcomes.

Objective

The aim of this study was to identify the incidence of short-term true outcomes of a syncopal episode, only considering those occurring after a reasonable period of time, with a plausible causal relationship with index syncope as well as syncopal recurrences causing major trauma.

Methods

In this retrospective, observational study, we assessed all patients managed in the emergency department (ED) during a 6-month period, with 30 days of follow-up.

Results

The study population consisted of 982 consecutive syncopal patients. We observed short-term serious events, in a broad sense, in 154 patients (15.7%), the most frequent being dysrhythmias (20.8%), cerebrovascular accidents (18.2%), major traumatic injuries (16.2%), death (13%), and myocardial infarction (9.7%). Most of these events (63.6%) could be identified within 72 h, mainly in the ED. Only 19 patients (2.2% of the sample), experienced a true short-term outcome (7 deaths, 1 myocardial infarction, 9 dysrhythmias, 1 major bleeding event, and 1 traumatic syncopal recurrence).

Conclusions

The incidence of short-term true outcomes of syncope is extremely low. Distinguishing true outcomes from other events has a crucial significance for understanding the real prognostic role of syncope and for planning ED management. Once patients with syncope as a direct consequence of an acute disease needing admission by itself are excluded, most patients with unexplained syncope could be safely discharged after primary evaluation and brief ED monitoring.

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