Initial Evaluation of Patients with Presumed Syncope
Syncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC). The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2008-01-01
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| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S188042760880018X |
| _version_ | 1818424579363700736 |
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| author | Ilknur Can, MD David G. Benditt, MD |
| author_facet | Ilknur Can, MD David G. Benditt, MD |
| author_sort | Ilknur Can, MD |
| collection | DOAJ |
| description | Syncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC). The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with sufficient confidence to assess prognosis and initiate an effective treatment strategy. The initial evaluation of these patients, which usually takes place in an emergency department (ED. or acute care facility, is challenging since patients are usually asymptomatic when they come for medical attention, may have little or no recall of the event, and witnesses, if any, often cannot provide reliable information. Given these circumstances, it is understandable that frontline physicians often tend to take a seemingly ‘safe’ approach, and admit both high-risk and intermediate-risk syncope patients to hospital. This strategy has many implications, including life-style and economic concerns for the patient, and health care management issues for physicians, hospital administrators and the overall health care system. The European Society of Cardiology (ESC. guidelines and several clinical studies provide helpful advice regarding “risk stratification” to help guide physicians in selecting patients for either early hospital admission or later oupatient subspeciality evaluation. The utility of syncope management units in the ED, and a guideline-based approach to the syncope patient, has tended to both diminish the number of undiagnosed cases and reduce the hospital admission rate. In this review, we have attempted to both highlight a cost-effective diagnostic pathway beginning with the initial evaluation of the patient with suspected syncope, and to provide criteria which may help frontline physicians better base their decisions regarding need for in-hospital versus outpatient clinic evaluation of syncope patients. |
| first_indexed | 2024-12-14T14:00:17Z |
| format | Article |
| id | doaj.art-00bc6e45969c4ccb93d41158f70c6e69 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 |
| language | English |
| last_indexed | 2024-12-14T14:00:17Z |
| publishDate | 2008-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-00bc6e45969c4ccb93d41158f70c6e692022-12-21T22:58:43ZengWileyJournal of Arrhythmia1880-42762008-01-0124311112110.1016/S1880-4276(08)80018-XInitial Evaluation of Patients with Presumed SyncopeIlknur Can, MDDavid G. Benditt, MDSyncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC). The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with sufficient confidence to assess prognosis and initiate an effective treatment strategy. The initial evaluation of these patients, which usually takes place in an emergency department (ED. or acute care facility, is challenging since patients are usually asymptomatic when they come for medical attention, may have little or no recall of the event, and witnesses, if any, often cannot provide reliable information. Given these circumstances, it is understandable that frontline physicians often tend to take a seemingly ‘safe’ approach, and admit both high-risk and intermediate-risk syncope patients to hospital. This strategy has many implications, including life-style and economic concerns for the patient, and health care management issues for physicians, hospital administrators and the overall health care system. The European Society of Cardiology (ESC. guidelines and several clinical studies provide helpful advice regarding “risk stratification” to help guide physicians in selecting patients for either early hospital admission or later oupatient subspeciality evaluation. The utility of syncope management units in the ED, and a guideline-based approach to the syncope patient, has tended to both diminish the number of undiagnosed cases and reduce the hospital admission rate. In this review, we have attempted to both highlight a cost-effective diagnostic pathway beginning with the initial evaluation of the patient with suspected syncope, and to provide criteria which may help frontline physicians better base their decisions regarding need for in-hospital versus outpatient clinic evaluation of syncope patients.http://www.sciencedirect.com/science/article/pii/S188042760880018Xsyncopeloss of cosciousnessrisk stratification |
| spellingShingle | Ilknur Can, MD David G. Benditt, MD Initial Evaluation of Patients with Presumed Syncope Journal of Arrhythmia syncope loss of cosciousness risk stratification |
| title | Initial Evaluation of Patients with Presumed Syncope |
| title_full | Initial Evaluation of Patients with Presumed Syncope |
| title_fullStr | Initial Evaluation of Patients with Presumed Syncope |
| title_full_unstemmed | Initial Evaluation of Patients with Presumed Syncope |
| title_short | Initial Evaluation of Patients with Presumed Syncope |
| title_sort | initial evaluation of patients with presumed syncope |
| topic | syncope loss of cosciousness risk stratification |
| url | http://www.sciencedirect.com/science/article/pii/S188042760880018X |
| work_keys_str_mv | AT ilknurcanmd initialevaluationofpatientswithpresumedsyncope AT davidgbendittmd initialevaluationofpatientswithpresumedsyncope |