Is the Evaluation of Syncope in the Emergency Department Adhere to the ESC Guidelines?

The evaluation of syncope in the emergency department and during hospitalization can be ineffective, unnecessary and expensive. The recent ESC guidelines were established to perform the evaluation based on risk stratification. The objective of the study was to investigate if the evaluation of syncope in real-life adheres to the recent ESC guidelines

Methods:

Patients with syncope who were evaluated in the emergency department and/or during hospitalization were included in the study and retrospectively analyzed to classify them based on whether they were or were not treated according to ESC guidelines. Further, patients were divided into 2 groups according to ESC guidelines risk profile: high or low risk.

Results:

114 patients (age 50.6 ± 21.96 years, 43% females) were included in the study. 74 (64.9%) patients had neurally mediated syncope, 11 (9.6%) had cardiac syncope and 29 (25.4%) had an unknown cause. Seventy patients (61.4%) were stratified in the low risk group, while 44 (38.6%) were stratified in the high-risk group. Only 48 (42.1%) were evaluated according to the guidelines. Twenty four (40%) of 60 hospitalizations and 41 (53.2%) of 77 Head CT scans were not mandatory according to guidelines. Rate of unnecessary CT (67.3% vs 28.6% respectively, p=0.001) and unnecessary hospitalization (70% vs 10% respectively, p<0.02) were higher among the low risk compared to high-risk patients. Overall, higher percentage of high-risk patients were treated according to guidelines compared to the low risk patients (68.2% vs 25.7% respectively, p =0.02).

Conclusion:

Most of syncope patients, particularly those with low-risk profile, were not evaluated in accordance to the guidelines in the emergency department/hospital.