• Felipe Rodríguez-Entem, Susana González-Enríquez, Juan J Olalla-Antolín, Manuel Cobo-Belaustegui, Víctor Expósito-García, Miguel Llano-Cardenal, Miguel A Casanova-Martín, and Cristina Ruisánchez.
• Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España. fentem@eurodivisas.com
• Rev Esp Cardiol. 2008 Jan 1;61(1):22-8.

Introduction And ObjectivesThe main aim of this study was to demonstrate that a protocol for managing syncope in the emergency department that is based on the early detection of heart disease enables patients to be diagnosed quickly and with few admissions, without there being a negative impact on prognosis.MethodsThe study was performed prospectively in 199 consecutive patients (54% male; mean age, 67 [17] years) who presented with syncope at the emergency department of our hospital during a 17-month period. A two-step diagnostic algorithm was developed in which patients initially underwent clinical and electro-cardiographic assessment, and thereafter were submitted to a diagnostic protocol that involved carrying out a sequence of diagnostic tests in the emergency room to avoid hospital admission.ResultsA presumptive diagnosis was established in 120 (60%) patients during the initial assessment. After completion of the diagnostic protocol, 78% of patients were given a clear diagnosis within a mean stay of 19 [15] h in the emergency department. Some 10% of patients were admitted. Three patients died during a mean follow-up period of 237 days.ConclusionsImplementation of a protocol for managing syncope in the emergency department that was based on screening patients according to the presence of heart disease enabled a large percentage to receive a diagnosis. Moreover, the majority of patients could be discharged rapidly from the emergency department without there being any negative impact on medium-term prognosis.

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