Assessment of a structured management pathway for patients referred to the Emergency Department for syncope: results in a tertiary hospital

Europace. 2016 Mar;18(3):457-62. doi: 10.1093/europace/euv106. Epub 2015 May 14.


Aims: High hospitalization rates (39-58% in the literature) of patients admitted to Emergency Department (ED) for transient loss of consciousness (T-LOC) suspected for syncope are still an unresolved issue. The presence of an Observation Unit has reduced hospital admissions and the duration of hospitalization in controlled studies, and a Syncope Unit (SU) in the hospital may reduce hospitalization and increase the number of diagnoses in patients with T-LOC. We assessed the effect of a structured organization on hospitalization rate and outcome.

Methods and results: Consecutive patients referred to the ED for a T-LOC of a suspected syncopal nature as the main diagnosis were included. The ED physician was trained to choose between: hospital admission (directly or after short observation); discharge after short (<48-h) observation; discharge on a fast track to the SU; and direct discharge without any further diagnostics. From January to June 2010, 362 patients were evaluated in the ED: 29% were admitted, 20% underwent short observation in the ED, 20% were referred to the SU, and 31% were directly discharged. Follow-up data were available on 295 patients who were discharged alive: of these, 1 (0.3%) previously hospitalized patient died within 30 days and 16 (5.4%) died within 1 year. Death rates were 12.9, 3.3, 0, and 2.5% among admitted, observation, SU, and ED-discharged patients, respectively. No death could be directly attributed to T-LOC. Re-admission within 1 year for any cause occurred in 72 (24%) patients; re-admission rates were 45.9, 19.3, 11.5, and 18.0% among admitted, observation, SU, and ED-discharged patients, respectively.

Conclusions: The availability of short observation and a SU seems to reduce the hospitalization rate compared with previous reported historical reports from our and other centres. Most deaths during follow-up occurred in patients who had been hospitalized. High rates of re-admission to the ED within 1 year are still an issue.

Keywords: Emergency department; Pathways; Syncope; Syncope Unit.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Pathways*
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Hospital Units / organization & administration*
  • Humans
  • Italy
  • Length of Stay
  • Male
  • Middle Aged
  • Models, Organizational
  • Observation*
  • Patient Admission*
  • Patient Discharge
  • Prognosis
  • Program Evaluation
  • Referral and Consultation / organization & administration*
  • Syncope / diagnosis*
  • Syncope / etiology
  • Syncope / mortality
  • Syncope / therapy
  • Tertiary Care Centers / organization & administration*
  • Time Factors
  • Young Adult