Establishing an approach to syncope in the emergency department.

A pilot study was conducted to enumerate the most common evaluations done in the emergency department (ED) of a community hospital in assessing patients presenting with a first episode of syncope and to determine the feasibility of defining a clinically useful set of investigations to identify the subset of syncopal patients that can be safely discharged from the ED. The study was conducted as a retrospective chart review of patients seen during an 8 week period. In the course of the study, 33 consecutive adult patients presenting to the ED with first episodes of syncope were identified. Patients were excluded if they had previous recurrent syncopal episodes or a known disorder leading to syncope. ED charts of the participants were reviewed to determine the types of investigations for syncope done by unblinded emergency physicians, which investigations showed abnormal results, and which were useful in determining etiology of syncope or in deciding which patients needed admission. The average number of investigations performed on each patient was 7 +/- 4, with a range of 1-17 investigations. Twelve percent of syncopal patients (4/33) were deemed, retrospectively, to have required hospital admission based on a review of their charts and follow-up interviews. Without specific clinical indicators, laboratory and radiologic investigations were not useful in determining either the etiology of the syncopal episode or the need for admission. In this small study, few patients presenting with new onset syncope required admission. The number and types of investigations performed on these patients was inconsistent. Further study is needed to determine whether syncopal patients requiring admission can be identified in the ED with a small number of standard inexpensive laboratory investigations.