Syncope An ED Approach To Risk Stratification
Authors: Donald J. Kosiak, Jr., MD. Wyatt W. Decker, MD, FACEP
Emergency Medicine Practice. Junuary 2004. Volume 6 Number 1
"Syncope is a common and challenging symptom that brings patients to the ED. It is estimated that 12%-40% of adults younger than 40 years will experience at least one episode of syncope, with up to 20%experiencing syncope before the end of adolescence. Patients older than 75 years have a reported 6% annual incidence of syncope. Syncope accounts for 3% of all ED visits and up to 6% of all hospital admissions.The overall cost per hospital admission was estimated to be about $5300 in 1996. According to data from the year 2000 collected by the Healthcare Cost and Utilization Project, syncope ranked 58 in a list of the top 100 diagnoses for U.S. hospital stays. Syncope accounted for 229,867 hospital discharges and an aggregate charge of $2,122,072,519.
Syncope has many causes, which range from benign, self-limited problems to immediately life-threatening events. The etiology of syncope can be difficult to diagnose. Syncope is a transient event, and not a specific disease entity; furthermore, the patient often is completely asymptomatic at the time of the evaluation. Also, the cause can be multifactorial, which makes a final diagnosis complicated. In as many as 50% of ED patients, no readily apparent diagnosis is available on ED discharge. The principal task of the ED practitioner is to identify those patients at risk for an adverse outcome. However, even with extensive and costly testing such as echocardiograms and electrophysiology studies, it is often difficult to be sure that the exact cause of syncope has been determined, or that potentially lethal causes have been ruled out. This issue of Emergency Medicine Practice is designed to help clinicians maximize the ED work-up of syncope as well as differentiate those patients who are at high risk for an adverse outcome from those who can safely be discharged home."