title: Syncope: risk stratification and clinical decision making.
abstract: Syncope is a common occurrence in the emergency department, accounting for approximately 1% to 3% of presentations. Syncope is best defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. The spectrum of etiologies ranges from benign to life threatening, and a structured approach to evaluating these patients is key to providing care that is thorough, yet cost-effective. This issue reviews the most relevant evidence for managing and risk stratifying the syncope patient, beginning with a focused history, physical examination, electrocardiogram, and tailored diagnostic testing. Several risk stratification decision rules are compared for performance in various scenarios, including how age and associated comorbidities may predict short-term and long-term adverse events. An algorithm for structured, evidence-based care of the syncope patient is included to ensure that patients requiring hospitalization are managed appropriately and those with benign causes are discharged safely.
authors.forename: Suzanne Y G
authors.initials: SY
authors.lastname: Peeters
authors.forename: Amber E
authors.initials: AE
authors.lastname: Hoek
authors.forename: Susan M
authors.initials: SM
authors.lastname: Mollink
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Huff
mesh_terms: D001334:Automobile Driving; D015415:Biomarkers / Q000097:blood; D053840:Brugada Syndrome / Q000175:diagnosis; D002318:Cardiovascular Diseases / Q000175:diagnosis; D002346:Carotid Sinus; D019091:Critical Pathways; D003657:Decision Making; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D064420:Drug-Related Side Effects and Adverse Reactions; D004562:Electrocardiography; D004632:Emergency Medical Services; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis; D007024:Hypotension, Orthostatic / Q000175:diagnosis; D002546:Ischemic Attack, Transient / Q000175:diagnosis; D008405:Massage; D008487:Medical History Taking; D001523:Mental Disorders / Q000175:diagnosis; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis; D020521:Stroke / Q000175:diagnosis; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*
chemical_list: D015415:Biomarkers