title: Syncope risk stratification in the ED.
abstract: Syncope may be the final common presentation of a number of clinical conditions spanning benign (i.e. neurally-mediated syncope) to life-threatening diseases (i.e. cardiac syncope). Hospitalization rate after a syncopal episode is high. An effective risk stratification is crucial to identify patients at risk of poor prognosis in the short term period to avoid unnecessary hospital admissions. The decision to admit or discharge a syncope patient from the ED is often based on the physician's clinical judgment. In recent years, several prognostic tools (i.e. clinical prediction rules and risk scores) have been developed to provide emergency physicians with accurate guidelines for hospital admission. At present, there are no compelling evidence that prognostic tools perform better than physician's clinical judgment in assessing the short-term outcome of syncope. However, the risk factors characterizing clinical prediction rules and risk scores may be profitably used by emergency doctors in their decision making, specifically whenever a syncope patient has to be discharged from ED or admitted to hospital. Patients with syncope of undetermined etiology, who are characterized by an intermediate-high risk profile after the initial evaluation, should be monitored in the ED. Indeed, data suggest that the 48h following syncope are at the highest risk for major adverse events. A new tool for syncope management is represented by the Syncope Unit in the ED or in an outpatient setting. Syncope Unit may reduce hospitalization and length of hospital stay. However, further studies are needed to clarify whether syncope patients' prognosis can be also improved.
authors.affiliation: Internal Medicine, Department of Medical Biotechnologies and Translational Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Italy. Electronic address: franca.dipaola@humanitas.it.
authors.forename: Franca
authors.initials: F
authors.lastname: Dipaola
authors.affiliation: Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Ospedale "L. Sacco", Milan, University of Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Costantino
authors.affiliation: Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Ospedale "L. Sacco", Milan, University of Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Solbiati
authors.affiliation: Internal Medicine, Department of Medical Biotechnologies and Translational Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Barbic
authors.affiliation: Internal Medicine, Department of Medical Biotechnologies and Translational Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Capitanio
authors.affiliation: Medicina ad Indirizzo Fisiopatologico, Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Ospedale "L. Sacco", Milan, University of Milan, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Tobaldini
authors.affiliation: Internal Medicine, Department of Medical Biotechnologies and Translational Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brunetta
authors.affiliation: Internal Medicine, Department of Medical Biotechnologies and Translational Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Italy; Department of Physical Therapy, Federal University of Sao Carlos, Brazil.
authors.forename: Antonio Roberto
authors.initials: AR
authors.lastname: Zamunér
authors.affiliation: Internal Medicine, Department of Medical Biotechnologies and Translational Medicine, Humanitas Clinical and Research Center, Rozzano, University of Milan, Italy.
authors.forename: Raffaello
authors.initials: R
authors.lastname: Furlan
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D003657:Decision Making; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D010343:Patient Admission; D011379:Prognosis; D012306:Risk; D013575:Syncope / Q000175:diagnosis* / Q000628:therapy
chemical_list: D015415:Biomarkers
keywords: Emergency department; Prognosis; Risk stratification; Syncope