title: Hospital admission of patients referred to the Emergency Department for syncope: a single-hospital prospective study based on the application of the European Society of Cardiology Guidelines on syncope.
abstract: OBJECTIVE
  To evaluate the applicability and the clinical impact of the European Society of Cardiology (ESC) Guidelines' recommendations for hospital admission of patients with syncope in a District Hospital Emergency Department (ED).
  
  
  RESULTS
  From September 2002 to August 2004, 1124 patients with syncope [out of 1308 with transient loss of consciousness (TLC)] were evaluated according to the ESC Guidelines. Overall, 566 patients with syncope (50.1%) were admitted and 558 (49.9%) were discharged. Out of the 1124 patients with syncope, 440 (39.1%) presented at least one ESC Guidelines' criterion for hospitalization. Out of the 440, 393 (89.3%) were admitted, whereas 511 out of the 684 (74.7%) without indication for admission were discharged. A significant difference was found between the adherence rates for admission and for discharge (P<0.001). The appropriateness of the ED medical decision was 69.4% for hospital admission and 91.6% for discharge (P<0.001).
  
  
  CONCLUSIONS
  Although an acceptable ED adherence to the guidelines' indications was attained, better implementation strategies are still advisable. The ESC Guidelines' indications are applicable to the majority of patients entering the ED for a TLC. In addition, when the guidelines' indications are observed, a high percentage of patients with syncope have still to be hospitalized.
authors.affiliation: Cardiology Division, Nuovo San Giovanni di Dio Hospital, Costa dei Magnoli 28, 50125 Florence, Italy. angelobartoletti@libero.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Bartoletti
authors.forename: Plinio
authors.initials: P
authors.lastname: Fabiani
authors.forename: Paolo
authors.initials: P
authors.lastname: Adriani
authors.forename: Francesca
authors.initials: F
authors.lastname: Baccetti
authors.forename: Luciano
authors.initials: L
authors.lastname: Bagnoli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Buffini
authors.forename: Carlo
authors.initials: C
authors.lastname: Cappelletti
authors.forename: Paolo
authors.initials: P
authors.lastname: Cecchini
authors.forename: Roberto
authors.initials: R
authors.lastname: Gianni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lavacchi
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Ticali
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Santoro
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013575:Syncope / Q000628:therapy*