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
. 2024 Jun 9.
doi: 10.1111/acem.14943. Online ahead of print.

Serious outcomes among emergency department patients with presyncope: A systematic review

Hadi Mirfazaelian  1   2 , Ian Stiell  3   4   5 , Rasoul Masoomi  6 , Khazar Garjani  1 , Venkatesh Thiruganasambandamoorthy  3   4   5
Affiliations
Free article

Serious outcomes among emergency department patients with presyncope: A systematic review

Hadi Mirfazaelian et al. Acad Emerg Med. .
Free article

Abstract

Background: Syncope is transient loss of consciousness, and in presyncope, patients experience same prodromal symptoms without losing consciousness. While studies have extensively reported the risk of serious outcome among emergency department (ED) syncope, the outcome for patients with presyncope and their management are not well studied. We undertook a systematic review to assess the occurrence/identification of short-term (30-day) serious outcomes among ED patients with presyncope.

Methods: ED studies that enrolled patients with presyncope and reported any short-term serious outcome were included. Studies that enrolled patients without presyncope (e.g., hypoglycemia, seizure, and stroke) were excluded. We restricted our study to only English publications and searched the MEDLINE, Embase, Scopus, and Web of Science from the inception date to July 2023. We used SIGN 50 tool for assessment of risk of bias.

Results: In total, 1788 articles were screened by two reviewers and 32 articles were selected for full-text assessment. Five (four prospective and one retrospective) studies with 2741 presyncope patients were included. Four studies were from North America and the fifth one was from Europe. Included studies had weaknesses due to risk of bias, but all had acceptable quality. The prevalence of overall adverse outcome varied 4.4%-26.8% for all adults and 5.5%-18.7% among older patients; arrhythmia was the most prevalent (17.4% in one study), followed by anemia/hemorrhage as reported in different studies. Among older patients, myocardial infarction was the third most common serious outcome reported in one study.

Conclusions: The prevalence of short-term serious outcomes varies from 4% to 27% among ED patients with presyncope in our review, with arrhythmia being the most common serious outcome. Our review indicates that presyncope may carry a similar risk to syncope, and hence, the same level of caution should be exercised for ED presyncope management as syncope.

Keywords: adverse outcomes; emergency department; presyncope; prognosis; syncope.

PubMed Disclaimer

References

REFERENCES

    1. Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2017;70(5):620‐663.
    1. Probst MA, Kanzaria HK, Gbedemah M, Richardson LD, Sun BC. National trends in resource utilization associated with ED visits for syncope. Am J Emerg Med. 2015;33(8):998‐1001.
    1. Quinn JV, Stiell IG, McDermott DA, Sellers KL, Kohn MA, Wells GA. Derivation of the San Francisco syncope rule to predict patients with short‐term serious outcomes. Ann Emerg Med. 2004;43(2):224‐232.
    1. Sun BC, Emond JA, Camargo CA Jr. Characteristics and admission patterns of patients presenting with syncope to US emergency departments, 1992–2000. Acad Emerg Med. 2004;11(10):1029‐1034.
    1. Leafloor CW, Hong PJ, Mukarram M, Sikora L, Elliott J, Thiruganasambandamoorthy V. Long‐term outcomes in syncope patients presenting to the emergency department: a systematic review. Can J Emerg Med. 2020;22(1):45‐55.

LinkOut - more resources