The prevalence and prognostic significance of near syncope and syncope: a prospective study of 395 cases in an emergency department (the SPEED study).
BACKGROUND
The prognostic significance of near-syncope has not yet been adequately characterized.


METHODS
We collected prospective data on a consecutive series of patients seen in an emergency department with syncope (brief loss of consciousness, usually with loss of muscle tone) or near-syncope (a feeling that syncope is about to occur, but without actual loss of consciousness or muscle tone). We report on the prevalence, etiology, and prognosis of such events (the SPEED study). Patients were followed up at 30 days and at 6 months after the event.


RESULTS
From 17 July to 31 October 2011, 395 patients were seen in the emergency department for a chief complaint of syncope or near-syncope (3% of all emergency patients). Their median age was 70 years, and 55% were men. 62% had experienced syncope, and 38% near-syncope. The patients with near-syncope were younger than those with syncope ( 63 vs. 72 years, p < 0.014) and were also more commonly male (63% vs. 49%, p = 0.006). The two patient groups did not differ significantly with respect to their measured laboratory values and vital parameters or their accompanying medical conditions. Hospitalizations were more common for syncope than for near-syncope (86% vs. 70%, p < 0.001). Etiologies were similarly distributed in the two patient groups, with the main ones being reflex syncope, orthostatic syncope, cardiac syncope, and syncope of uncertain origin. In all, 123 of 379 patients (32%) had further undesired events within 30 days of the event. Multivariable logistic regression revealed that age, heart rate, and renal dysfunction were independent predictors of undesired events, while the type of syncope was not.


CONCLUSIONS
Patients with near-syncope do not differ to any large extent from patients with syncope with respect to the features studied. The diagnostic evaluation should be similar for patients in the two groups.
Department of Emergency and Critical Care Medicine, Nuremberg Hospital, Institute for Clinical Chemistry, Laboratory Medicine, and Transfusion Medicine, Nuremberg Hospital, Master Program M. Sc. Medical Process Management, Friedrich-Alexander-University Erlangen-Nürnberg, Department of Geriatrics, Nuremberg Hospital, Chairholder at the Department of Health Economics, Friedrich-Alexander-University Erlangen-Nürnberg, Departement of Internal Medicine, Universitätsspital Basel, Switzerland.
Yvonne
Y
Greve
Felicitas
F
Geier
Steffen
S
Popp
Thomas
T
Bertsch
Katrin
K
Singler
Florian
F
Meier
Alexander
A
Smolarsky
Harald
H
Mang
Christian
C
Müller
Michael
M
Christ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D013575:Syncope / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult