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Europace Advance Access published online on November 27, 2008
Europace, doi:10.1093/europace/eun323
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

CLINICAL RESEARCH

Management of syncope in the Emergency Department: a single hospital observational case series based on the application of European Society of Cardiology Guidelines

Frances McCarthy1,*, C. Geraldine McMahon2, Una Geary2, Patrick K. Plunkett2, Rose Anne Kenny1 and Conal J. Cunningham1

1 Department of Medicine for the Elderly, St James's Hospital, St James's Street, Dublin, Ireland; 2 Department of Emergency Medicine, St James's Hospital, Dublin, Ireland

Aims: The aim of this study was to evaluate the effect of introducing a European Society of Cardiology guideline-based Integrated Care Plan (ICP) for Syncope on hospital admissions and referral patterns to an outpatient Syncope Management Unit, of patients presenting to an Emergency Department (ED) with a syncopal episode and to determine the underlying causes of syncope.

Methods and results: This study is a single-centre observational case series of consecutive adult patients presenting to the ED over a 5-month period. Two hundred and fourteen of 18 898 patients (1.1%) had a syncopal episode, 110 (51.4%) of whom were admitted. Forty-six (41.8%) admissions were indicated by the ICP. All potential cardiac syncope cases were admitted. There was a 500% increase in the overall number of referrals to the Syncope Management Unit with a small increase in the number of unnecessary referrals.

Conclusion: The introduction of an ICP for syncope was not associated with any cases with potential adverse outcomes being lost to follow-up and resulted in increased referral rates to the syncope unit. However, hospitalization rates for syncope remain high, and a large number of patients requiring early outpatient assessment were not referred. There remains a need to develop further interventions to guide appropriate and safe syncope management in the ED.

Key Words: Syncope, Integrated Care Plan, Hospitalization, Guidelines

* Corresponding author. Tel: +353 879073392, Fax: +353 15054847, Email: francesmcc{at}eircom.net

Manuscript submitted 24 September 2008. Accepted after revision 3 November 2008.


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