Comparison Between Standard and Ultrasound Integrated Approach for Risk Stratification of Syncope in the Emergency Department
Comparison Between Standard and Ultrasound Integrated Approach for Risk Stratification of Syncope in the Emergency Department
This is a observational prospective study. For patients presenting to the Emergency
 Department with loss of consciousness, emergency physicians will be asked to screen the real
 syncope without an evident and immediate cause for the loss of consciousness (e.g. vasovagal)
 and/or at least one high risk condition as listed by the European Society of Cardiology in
 the 2009 Guidelines for the diagnosis and management of syncope (i.e. severe structural or
 coronary artery disease, clinical or ECG features suggesting arrhythmic syncope, and
 important co-morbidities).

 In case of a real syncope not clearly physiopathologically explained and no high risk
 conditions, the emergency physician in charge will check risk factors for high risk syncope
 and categorize again every cases.

 A high risk syncope is characterized by at least one high-risk characteristic (based on 2015
 "Syncope clinical management in the emergency department consensus"): syncope during
 exertion, in supine position, with new onset of chest discomfort, palpitations before the
 loss of consciousness, family history of sudden death, congestive heart failure, aortic
 stenosis, left ventricular outflow tract disease, dilated cardiomyopathy, hypertrophic
 cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular ejection
 fraction <35%, previously documented ventricular arrhythmia, coronary artery disease,
 congenital heart disease, previous myocardial infarction, pulmonary hypertension, previous
 ICD implantation, anemia (i.e. Hb <9 g/dl), lowest systolic blood pressure in the ED <90
 mmHg, sinus bradycardia (<40 bpm), new (or previously unknown) left bundle branch block,
 bifascicular block plus a first degree AV block, Brugada ECG pattern, ECG changes consistent
 with acute ischemia, a new non-sinus rhythm, bifascicular block, and a prolonged QTc (>450
 ms).

 Low and intermediate risk syncopes will be enrolled and evaluated using an integrated
 point-of-care sonographic approach (based on history, physical exam, electrocardiogram, and
 lung, focus cardiac and venous compression ultrasonography).

 After discharge, the risk of patient's syncope will be determined by reviewing the entire
 medical records.
Inclusion Criteria:

 -  patients evaluated in the Emergency Department for loss of consciousness

 Exclusion Criteria:

 -  identification of cause of loss of consciousness after initial evaluation;

 -  loss of consciousness classified as high risk syncope.