Journal Mobile

I Can, DG Benditt
Journal Issue: 
Volume 39: Issue 3: 2009




Syncope  is  one  element  of  the  broader  issue  of  ‘transient  loss  of consciousness’,  but  is  nevertheless  a  very  common  clinical  problem.  Emergency department physicians and general practitioners are often the first physicians to evaluate  the  patient. After  ensuring  that  any  serious  injury  is  treated,  the  most important  task  is  to  decide  whether  to  admit  patients  to  hospital.  Physicians usually take the ‘safe’ approach and, as a result, admit both high- and intermediate-risk patients to hospital. This is understandable, but has implications for both the patient and for the management of the healthcare system. The European Society of  Cardiology  guidelines  and  several  clinical  studies  provide  helpful  advice regarding ‘risk  stratification’  of  patients  for  hospital  admission  versus  discharge from the emergency department or clinic with subsequent outpatient subspeciality evaluation.  Syncope  management  units  and  a  guideline-based  approach  tend  to reduce  the  number  of  undiagnosed  cases  and  the  hospital  admission  rate. This review describes this approach for managing these patients effectively.