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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Monday, February 15, 2021

Syncope: discharge or admit ?

emDocs - February 14, 2021 - By  Aaron Blau
Reviewed by: Mark Ramzy; Alex Koyfman; Brit Long,
"Question: For patients presenting with syncope of unknown etiology, who needs to be admitted and who can go home?
Pearls
  • Many patients with syncope can go home after evaluation for etiology, assessment of risk factors, and obtaining a reassuring EKG.
  • Clinical judgment alone often tends to err on the side of conservative dispositions and can lead to higher admission rates.
  • Decision-making tools, despite their varying level of external validation, can be used to reassure clinicians and assist in shared decision-making when considering safe discharge of syncopal patients.
  • The SFSR requires only basic labs (CBC, BMP) and a standard workup, and is the easiest to remember at the bedside, but sensitivity for adverse events was much lower in external validation studies. The CSRS requires more extensive laboratory testing but has proven more reliable in external validation. The FAINT score appears promising for older patients who present with syncope, but requires external validation before widespread clinical use."