Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Apr 1;31(2):136-146.
doi: 10.1097/MEJ.0000000000001101. Epub 2023 Nov 27.

Management of syncope in the Emergency Department: a European prospective cohort study (SEED)

Matthew J Reed  1   2 , Suvi Karuranga  3 , David Kearns  4 , Salma Alawiye  1 , Ben Clarke  1 , Martin Möckel  5 , Mehmet Karamercan  6 , Kelly Janssens  7 , Luis Garcia-Castrillo Riesgo  8 , Francisco Moya Torrecilla  9 , Adela Golea  10 , Juan Antonio Fernández Cejas  11 , Eugenia Maria Lupan-Muresan  12 , Edmond Zaimi  13 , Alexander Nuernberger  14 , Ondřej Rennét  15 , Christian Skjaerbaek  16 , Effie Polyzogopoulou  17 , Judit Imecz  18 , Paolo Groff  19 , Rene Camilleri  20 , Diana Cimpoesu  21 , Miljan Jovic  22 , Òscar Miró  23 , Rory Anderson  24 , Said Laribi  25 ; SEED investigators
Affiliations
Observational Study

Management of syncope in the Emergency Department: a European prospective cohort study (SEED)

Matthew J Reed et al. Eur J Emerg Med. .

Abstract

Background and importance: In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe.

Objectives: To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope).

Design: Prospective, multicentre, observational cohort study.

Settings and participants: Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin.

Main results: Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries.

Conclusion: This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.

Trial registration: ClinicalTrials.gov NCT05571254.

PubMed Disclaimer

References

    1. Brignole M, Moya A, Deharo J-C, de Lange F, Elliott P, Fedorowski A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39:1883–1948.
    1. Kenny R, Bhangu J, King-Kallimanis B. Epidemioloy of syncope/collapse in younger and older western patient populations. Prog Cardiovasc Dis 2013; 55:357.
    1. Casagranda I, Brignole M, Cencetti S, Cervellin G, Costantino G, Furlan R, et al. Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the emergency department. Emergen Care J 2016; 12: 1–3.
    1. Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol 2010; 55:713–721.
    1. Colivicchi F, Ammirati F, Melina D, Guido V, Imperoli G, Santini M; OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003; 24:811–819.

Publication types

Associated data