Background: Little is known about the frequency of patients presenting to the emergency department with syncope. Regarding mortality and predictors of outcome the literature remains inconclusive.
Aims: The aims of the study were to determine the frequency of patients presenting with syncope to an emergency department, to assess mortality among these patients and to determine potential predictors of poor outcome.
Methods: Data of all consecutive patients who were treated at our emergency department between January 1st 1994 and September 1st 1997 following syncope were collected retrospectively. The presumptive causes of syncope were classified into six categories (cardiogenic, neurogenic, autonomic dysfunction, psychiatric, toxic/alcoholic, idiopathic/unexplained). Patients were followed until December 31st, 1997.
Results: 701 patients (0.35% of all emergency department visits) were treated for this reason. 507 patients were eligible for the study. During follow-up 8% (n = 38) of the patients died. Three patients died within the first 28 days, all with a known severe underlying disease (congestive heart failure, malignancy, ischemic cerebral infarction). Non-survivors more frequently had a cardiogenic (34%) or neurogenic (13%) cause of syncope (p < 0.01). Age > 60 years, syncope due to neurogenic cause and abnormal ECG findings were independent predictors of increased mortality.
Conclusions: Patients with syncope only comprise a small proportion of those seen at the emergency department. Mortality among these patients is 8%. Clinical history and ECG findings are major determinants of risk stratification: Age > 60 years, syncope due to neurogenic causes and abnormal ECG are independent predictors of poor outcome.