Syncope Patient Evaluation in the Emergency Department
Syncope Patient Evaluation in the Emergency Department
Patients with the symptom complex syncope or near-syncope are quite often in the emergency
 department. Most patients with syncope have a positive prognosis. However some types of
 syncope are associated with an increased morbidity and mortality. It is a challenge to detect
 these patients reliably at an early stage. The current guidelines contain exact definitions
 concerning the characteristics of patients with syncope and recommendations on how to
 diagnose and treat these patients following standardized pathways. Due to the fact that
 near-syncope is poorly defined and therefore seldom evaluated in clinical trials, data
 concerning near-syncope are rare.

 Our aim was to characterize patients presenting with syncope or near-syncope to the emergency
 department regarding their risk profile, comorbidities and prognosis. First we evaluated if
 there is a difference between the two groups syncope and near-syncope concerning type and
 frequency of adverse events. Furthermore we analyzed the routinely measured cardiac
 biomarkers NT-proBNP and hs cTnT in patients with syncope or near-syncope. Then we determined
 both their prognostic accuracy in predicting adverse events and their diagnostic accuracy in
 finding the underlying etiology. Finally we analyzed a special patient collective, patients
 aged ≥ 65 years. It is assumed that elderly patients are suffering from comorbidities and
 age-related physiological and cognitive disabilities. We therefore hypothesize that elderly
 patients, in contrast to patients aged < 60, display an increased risk of adverse events and
 that they have a poorer prognosis.
Inclusion Criteria:

 -  (near) syncope

 Exclusion Criteria:

 -  age < 18 years

 -  progressive impairment of consciousness

 -  use of mind-altering drugs

 -  non syncopal loss of consciousness: hyperventilation, hypoglycaemia, metabolic
 disorders, psychogenic pseudosyncope, TIA or stroke, seizure, transient loss of
 consciousness caused by craniocerebral injury