• Matthew J Reed, Suvi Karuranga, David Kearns, Salma Alawiye, Ben Clarke, Martin Möckel, Mehmet Karamercan, Kelly Janssens, RiesgoLuis Garcia-CastrilloLGHospital Universitario Marques de Valdecilla, SCS, Santander., Francisco Moya Torrecilla, Adela Golea, Juan Antonio Fernández Cejas, Eugenia Maria Lupan-Muresan, Edmond Zaimi, Alexander Nuernberger, Ondřej Rennét, Christian Skjaerbaek, Effie Polyzogopoulou, Judit Imecz, Paolo Groff, Rene Camilleri, Diana Cimpoesu, Miljan Jovic, Òscar Miró, Rory Anderson, Said Laribi, and SEED investigators.
• Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh.
• Eur J Emerg Med. 2024 Apr 1; 31 (2): 136146136-146.

Background And ImportanceIn 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe.ObjectivesTo examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope).DesignProspective, multicentre, observational cohort study.Settings And ParticipantsAdults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin.Main ResultsBetween 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries.ConclusionThis European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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