Do patients with a negative Emergency Department evaluation for syncope require hospital admission?

J Emerg Med. 2004 Nov;27(4):339-43. doi: 10.1016/j.jemermed.2004.04.017.


Is hospitalization needed for patients in whom an underlying cause of syncope is not detected in the Emergency Department (ED)? To answer this question, we conducted a prospective, short-term outcomes study of consecutive patients > or = 50 years old presenting to our ED after a syncopal episode. All subjects received a structured ED evaluation. Forty-five patients met inclusion criteria, 67% were hospitalized. None of the patients experienced a life-threatening event or required significant therapeutic interventions during the hospitalization. No patient had a new diagnosis relevant to syncope. Follow-up interviews 1 month later revealed no repeat ED visits, hospitalizations, or deaths (95% upper CI, 6.5%). One patient reported a recurrent syncope (recurrence 2.2% [95% upper CI, 10%]). This pilot study suggests that a negative structured ED evaluation may identify patients > or = 50 years of age who may be safely discharged from the ED. Further validation is required before this observation is applied to clinical practice.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Diagnostic Tests, Routine
  • Emergency Medical Services
  • Emergency Service, Hospital
  • Female
  • Hospitalization / economics*
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Pilot Projects
  • Prospective Studies
  • Syncope / diagnosis*
  • Syncope / therapy