Syncope: First Evaluation and Management in the Emergency Department

  • Franco Giada
  • Andrea Nordio


Epidemiological studies conducted in the USA have estimated that 30 % of the general population experiences at least one episode of syncope in their lifetime [1], which is responsible for about 1–3 % of admissions to the emergency department (ED) and 1–3 % of hospitalizations [2]. In Italy, syncope accounts for 1–2 % of both admissions to the ED and all hospitalizations [3–7]. About half of the patients attending emergency facilities for syncope are subsequently hospitalized; the mean duration of hospitalization is about 8 days [3–7]. Moreover, in industrialized countries the progressive aging of the population, together with the higher prevalence of syncope among elderly subjects, are likely to increase the impact of syncope on healthcare systems in the near future [6].


Emergency Department Orthostatic Blood Pressure Initial Clinical Evaluation Progressive Aging Subclavian Steal Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Savage DD, Corwin L, McGee LD, et al. Epidemiology features of isolated syncope: the Framingham study. Stroke. 1985;16:626–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Day SC, Cook EF, Funkenstain H, Goldman L. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med. 1982;73:15–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Ammirati F, Colivicchi F, Minardi G, et al. Gestione della sincope in ospedale: lo studio OESIL (Osservatorio Epidemiologico della Sincope nel Lazio). G Ital Cardiol. 1999;29:533–9.PubMedGoogle Scholar
  4. 4.
    Del Greco M, Cozzio S, Scillieri M, Cappari F, Scivales A, Disertori M. The ECSIT study (Epidemiology and Costs of Syncope in Trento). Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. Ital Heart J. 2003;4:99–106.PubMedGoogle Scholar
  5. 5.
    Haan MN, Selby JV, Quensenberry CP, et al. The impact of aging and chronic disease on use of hospital and outpatient service in a large HMO. J Am Geriatr Soc. 1997;45:667–74.CrossRefPubMedGoogle Scholar
  6. 6.
    Nyman JA, Krahn AD, Bland PC, et al. The costs of recurrent syncope of unknown origin in elderly patients. PACE. 1999;22:1386–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Olde Nordkamp LAR, van Dijk N, Ganzeboom KS, Reitsma JB, Luitse JSK, Dekker LRC, et al. Syncope prevalence in ED compared to that in the general practice and population: a strong selection process. Am J Emerg Med. 2009;27:271–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Sun BC, et al. Direct medical costs of syncope-related hospitalizations in the United States. Am J Cardiol. 2005;95(5):668–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Del Rosso A, Bernadeschi M, Ieri A. Costi sociali della sincope. Ital Heart J Suppl. 2000;1:772–6.PubMedGoogle Scholar
  10. 10.
    The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS). Guidelines for the diagnosis and management of syncope. Eur Heart J. 2009;30(21):2631–71.CrossRefGoogle Scholar
  11. 11.
    Giada F, Ammirati F, Bartoletti A, Del Rosso A, Dinelli M, Foglia-Manzillo G, et al. La Syncope Unit: un nuovo modello organizzativo per la gestione del paziente con sincope. G Ital Cardiol. 2010;11:323–8.Google Scholar
  12. 12.
    Colivicchi F, Ammirati F, Melina D, Guido V, Imperoli G, Santini M. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J. 2003;24:811–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2009;94:1620–6.CrossRefGoogle Scholar
  14. 14.
    Shen WK, Decker WW, Smars PA, Goyal DG, Walker AE, Hodge DO, et al. Syncope evaluation in the emergency department study (SEEDS). A multidisciplinary approach to syncope management. Circulation. 2004;110:3636–45.CrossRefPubMedGoogle Scholar
  15. 15.
    Brignole M, Disertori M, Menozzi C, et al. The management of syncope referred for emergency to general hospitals with and without Syncope Unit facility. Europace. 2003;5:293–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Disertori M, Brignole M, Menozzi C, et al. Management of syncope referred for emergency to general hospitals. Europace. 2003;5:283–91.CrossRefPubMedGoogle Scholar
  17. 17.
    Brignole M, Menozzi C, Bartoletti A, Giada F, Lagi A, Ungar A, et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J. 2006;27:76–82.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Cardiovascular DepartmentP.F. Calvi HospitalNoale-VeniceItaly
  2. 2.Cardiovascular DepartmentOspedali Riuniti and University of TriesteTriesteItaly

Personalised recommendations