title: [The syncope in Emergency Department: usual management vs guidelines].
abstract: BACKGROUND
  The syncope is a common cause of admission to Emergency Departments, representing around 1-3% of all admissions to the service. However, elderly age and important comorbidities often hinder a definite etiologic diagnosis, with increasing requests for diagnostic tests and longer periods of hospitalization.
  
  
  METHODS
  We analyzed the management of 1,204 patients admitted to our Emergency Department for transient loss of consciousness in the period between 1 June 2009 and 1 June 2010, evaluating the following parameters: average age, gender, triage color code at admittance, performed diagnostic tests, diagnosis at discharge from ED and destination ward. We also studied a subgroup of 93 patients admitted to emergency medicine units evaluating their OESIL score at admittance, comorbidities, performed diagnostic tests and diagnosis at discharge from the ward.
  
  
  RESULTS
  In the Emergency Department, 45% of patients were discharged with a diagnosis of syncope of unknown origin; in 21% of patients syncope was excluded; 19% of patients received a diagnosis of cardiogenic syncope; 11% were diagnosed with a presyncope; 3% with orthostatic hypotension and 1% with vasovagal syncope. In emergency medicine units, 51% of patients were discharged with a diagnosis of cardiogenic syncope, 11% were diagnosed with vasovagal syncope, 11% with presyncope, 11% with TIA, 8% with loss of consciousness non-syncope and 8% with syncope of unknown origin.
  
  
  CONCLUSIONS
  Management of patients with syncope, elderly people with important comorbidities in particular, is still a serious problem for the emergency physician. The creation of specialized units for the management of syncope, the so-called syncope units, through the implementation of a shared diagnostic and therapeutic protocol, aims at reducing inappropriate hospitalization and average length of stay.
authors: Dipartimenti di Emergenza UOC di Medicina d'Urgenza, Università degli Studi "Sapienza", Roma, Italia.
authors: A
authors: A
authors: Bianchi
authors: E
authors: E
authors: Baldini
authors: M
authors: M
authors: Suppa
authors: A
authors: A
authors: Rosa
authors: A
authors: A
authors: Coppola
authors: F
authors: F
authors: Cavicchi
authors: E
authors: E
authors: Contu
authors: C
authors: C
authors: Petroni
authors: S
authors: S
authors: Strano
authors: M G
authors: MG
authors: Scarpellini
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology