Prediction of serious clinical outcomes in patients presenting with syncope in the short-term follow-up: Which variables to use?

Aim: This study aims to identify patient groups diagnosed with syncope in the emergency department (ED) based on initial evaluation, distinguish those whose etiology remains unclear necessitating hospitalization, and assess factors influencing serious clinical outcomes (SCOs) within 30 days post-ED admission for suspected syncope.Material and Methods: This prospective, single-center observational study included patients presenting to the ED with suspected syncope over a six-month period.Subjects were categorized into three groups: those diagnosed and discharged following initial testing in the ED, those requiring hospitalization, and those undiagnosed in the ED but discharged for outpatient follow-up within 24 hours.The study's primary endpoint was the incidence of SCO, with secondary analysis focusing on determinants of SCO.Results: The study encompassed 257 patients, among whom 22 (8.6%) experienced serious clinical outcomes (SCOs).The incidence of SCO was significantly higher at 22.2% among Group 2 patients, who required hospitalization, compared to those discharged directly from the emergency department (ED) (p=0.013).Notably, 62.9% of the hospitalized patients (Group 2) were diagnosed with cardiac syncope, while 11.1% had an undetermined cause of syncope despite ED evaluation.Abnormalities in electrocardiogram (ECG) were observed in 59.1% (n=13) of the patients who experienced SCOs (p<0.001).Discussion: The data indicates a statistically significant increase in SCOs among patients admitted to the hospital compared to those discharged from the ED.Moreover, the presence of a normal ECG appears to correlate with a lower likelihood of experiencing SCOs, underscoring the value of ECG as a predictive tool in the assessment of syncope.