Do Orthostatic Vital Signs Have Utility in the Evaluation of Syncope?

J Emerg Med. 2018 Dec;55(6):780-787. doi: 10.1016/j.jemermed.2018.09.011. Epub 2018 Oct 10.


Background: Syncope is a common presentation in the emergency department (ED). The differential diagnosis is long and includes benign conditions as well as acute life threats, such as dysrhythmias or pulmonary embolism.

Objective: The specific goals of this review are twofold: 1) to define the diagnostic utility of orthostatic vital signs (OVS) as a test for orthostatic syncope, and 2) to determine whether OVS help diagnose or exclude life-threatening causes of syncope in ED patients.

Methods: Three prospective cohort studies plus 2017 national guidelines for syncope management were identified, reviewed, and critically appraised.

Results: This literature review found that orthostatic hypotension is common among ED patients with syncope and is often diagnosed as the cause of syncope.

Conclusions: OVS measurements do not, in isolation, reliably diagnose or exclude orthostatic syncope, nor do they appear to have value in ruling out life-threatening causes of syncope.

Keywords: dehydration; diagnostic tests; orthostatic vital signs; syncope.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Emergency Service, Hospital*
  • Humans
  • Hypotension, Orthostatic / diagnosis*
  • Syncope / diagnosis*
  • Vital Signs*