Practical Approaches to Care in Emergency Syncope

Syncope, or transient loss of consciousness, is a common reason for visit to the Emergency Department and often leads to extensive testing and hospitalization. Using objective risk scores to determine which patients with syncope will actually benefit from these interventions, and which can be safely discharged home with minimal testing, is critical to providing sensible medical care. This study will evaluate the validity of two syncope risk-stratification tools and investigate their impact on healthcare utilization and patient safety, thus improving the quality of care for the 1-2 million patients who experience syncope every year in the United States

Inclusion Criteria:

- Adult patients 40 years of age or older who present to the Emergency Department with syncope or presyncope.

- Subjects must read and speak English or Spanish.

- Subjects must have a working phone number and fixed address.

Exclusion Criteria:

- Patient who have a syncope mimic such as seizure, stroke, head trauma with loss of consciousness, altered mental status, hypoglycemia, intoxication, or require an intervention to restore consciousness.

- Patients who have a new serious diagnosis found in the Emergency Department, such as death, significant cardiac arrhythmia (see below), myocardial infarction, significant structural heart disease, stroke (both ischemic and hemorrhagic), pulmonary embolism, aortic dissection, hemorrhage or anemia requiring blood transfusion, subarachnoid hemorrhage, cardiopulmonary resuscitation, acute surgical illness, pregnancy, or major traumatic injury.

- Significant cardiac arrhythmia includes Ventricular Fibrillation, Ventricular tachycardia (>30 secs), Symptomatic ventricular tachycardia, (<30 secs), Sick sinus disease with alternating sinus bradycardia and tachycardia, Sinus pause > 3 seconds, Mobitz type II atrioventricular heart block, Complete heart block, Symptomatic supraventricular tachycardia (including Paroxysmal Supraventricular Tachycardia (PSVT), rapid atrial fibrillation/ flutter), Symptomatic bradycardia (pulse<40), Pacemaker or implantable cardioverter-defibrillator malfunction with cardiac pauses.

Conditions:
• Syncope
• Emergencies