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. 2014 Mar 21;111(12):197-204.
doi: 10.3238/arztebl.2014.0197.

The prevalence and prognostic significance of near syncope and syncope: a prospective study of 395 cases in an emergency department (the SPEED study)

Yvonne Greve  1 , Felicitas Geier, Steffen Popp, Thomas Bertsch, Katrin Singler, Florian Meier, Alexander Smolarsky, Harald Mang, Christian Müller, Michael Christ
Affiliations

The prevalence and prognostic significance of near syncope and syncope: a prospective study of 395 cases in an emergency department (the SPEED study)

Yvonne Greve et al. Dtsch Arztebl Int. .

Abstract

Background: The prognostic significance of near-syncope has not yet been adequately characterized.

Method: We collected prospective data on a consecutive series of patients seen in an emergency department with syncope (brief loss of consciousness, usually with loss of muscle tone) or near-syncope (a feeling that syncope is about to occur, but without actual loss of consciousness or muscle tone). We report on the prevalence, etiology, and prognosis of such events (the SPEED study). Patients were followed up at 30 days and at 6 months after the event.

Results: From 17 July to 31 October 2011, 395 patients were seen in the emergency department for a chief complaint of syncope or near-syncope (3% of all emergency patients). Their median age was 70 years, and 55% were men. 62% had experienced syncope, and 38% near-syncope. The patients with near-syncope were younger than those with syncope ( 63 vs. 72 years, p < 0.014) and were also more commonly male (63% vs. 49%, p = 0.006). The two patient groups did not differ significantly with respect to their measured laboratory values and vital parameters or their accompanying medical conditions. Hospitalizations were more common for syncope than for near-syncope (86% vs. 70%, p < 0.001). Etiologies were similarly distributed in the two patient groups, with the main ones being reflex syncope, orthostatic syncope, cardiac syncope, and syncope of uncertain origin. In all, 123 of 379 patients (32%) had further undesired events within 30 days of the event. Multivariable logistic regression revealed that age, heart rate, and renal dysfunction were independent predictors of undesired events, while the type of syncope was not.

Conclusion: Patients with near-syncope do not differ to any large extent from patients with syncope with respect to the features studied. The diagnostic evaluation should be similar for patients in the two groups.

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Figures

Figure 1
Figure 1
Parties admitting patients who presented to the emergency department with syncope or near syncope
Figure 2
Figure 2
Endpoints of patients who presented to the emergency department with syncope or near syncope. Frequencies are shown for hospitalization, the combined endpoint serious adverse event or intervention within 30 days, and the endpoint death within 30 days following the index event, according to whether the patient presented to the emergency room with syncope or near syncope.
Figure 3
Figure 3
Kaplan–Meier analysis of patients presenting to a German emergency department with syncope or near syncope. The figure shows the survival curves for the endpoint death (a) and the combined endpoint event-free survival (b).
eFigure 1
eFigure 1
Recruitment of syncope or near syncope patients included in analysis (July 17, 2011 to October 31, 2011) ED: Emergency department; TIA: Transient ischemic attack
eFigure 2
eFigure 2
Etiology of syncope and near syncope and distribution of causes in patients with syncope and near syncope
eFigure 3
eFigure 3
Further care received by patients with syncope or near syncope after presenting to a German emergency department ICU: Intensive care unit; IMC: Intermediate care unit
See this image and copyright information in PMC

Comment in

  • Difficult to categorize.
    Möckel M, Searle J. Möckel M, et al. Dtsch Arztebl Int. 2014 Aug 18;111(33-34):566. doi: 10.3238/arztebl.2014.0566a. Dtsch Arztebl Int. 2014. PMID: 25220069 Free PMC article. No abstract available.
  • In reply.
    Christ M, Greve Y. Christ M, et al. Dtsch Arztebl Int. 2014 Aug 18;111(33-34):566. doi: 10.3238/arztebl.2014.0566b. Dtsch Arztebl Int. 2014. PMID: 25220070 Free PMC article. No abstract available.

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