Syncope in the emergency department: comparison of standardized admission criteria with clinical practice

Aims Syncope is a major health care problem that accounts for many emergency department (ED) and hospital admissions. This study was conducted to investigate the short-term risk of serious events in patients presenting to the ED with syncope and to compare guideline-based admission criteria with those adopted in clinical practice. Methods and results A single-centre retrospective analysis was performed on ED visits between January and June 2009. We used the ICD-9 code 780.2 for syncope as the primary diagnosis. The prevalence of serious events within 7 days of the index presentation was evaluated. In addition, admissions and discharges were classified as being appropriate or inappropriate based on standardized guideline-based criteria integrated in a new Faint-Algorithm developed at the University of Utah. Two hundred and fifty-four ED visits met the inclusion criteria. One hundred and thirty-six patients were discharged home and the remaining 118 were admitted. The prevalence of serious events in the discharged and admission groups were 5 and 10, respectively, (P = NS). According to the Faint-Algorithm, the number of inappropriate discharges and admissions were 8 out of 136 and 69 out of 118, respectively. Using the Faint-Algorithm, only 57 patients instead of 118 patients should have been admitted resulting in a 52% reduction in admission rate. Furthermore, in the remaining 197 patients who should have been discharged, the prevalence of serious events was not significantly different than that observed in the 136 patients who were actually discharged (3% vs. 4%). Conclusion There are significant numbers of inappropriate discharges and admissions in patients presenting with syncope. The standardized guideline-based criteria integrated in the new Faint-Algorithm provide promise but require further prospective evaluation.