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Reed MJ, Karuranga S, Kearns D, Alawiye S, Clarke B, Möckel M, Karamercan M, Janssens K, Riesgo LGC, Torrecilla FM, Golea A, Fernández Cejas JA, Lupan-Muresan EM, Zaimi E, Nuernberger A, Rennét O, Skjaerbaek C, Polyzogopoulou E, Imecz J, Groff P, Camilleri R, Cimpoesu D, Jovic M, Miró Ò, Anderson R, Laribi S. Management of syncope in the Emergency Department: a European prospective cohort study (SEED). Eur J Emerg Med 2024; 31:136-146. [PMID: 38015745 DOI: 10.1097/mej.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND IMPORTANCE In 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. OBJECTIVES To 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). DESIGN Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS Between 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. CONCLUSION This 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.
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Affiliation(s)
- Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Suvi Karuranga
- European Society for Emergency Medicine, Antwerp, Belgium
| | - David Kearns
- University of Edinburgh Medical School, Edinburgh, UK
| | - Salma Alawiye
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Ben Clarke
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Campus Mitte and Virchow, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Mehmet Karamercan
- Department of Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kelly Janssens
- St Vincents University Healthcare Group, Dublin, Ireland
| | | | | | - Adela Golea
- Emergency Unit, University of Medicine and Pharmacy Cluj, University Emergency County Hospital, Cluj Napoca, Romania
| | | | - Eugenia Maria Lupan-Muresan
- Emergency Medicine Discipline, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Edmond Zaimi
- University Hospital Centre, Mother Teresa of Tirana, Tirana, Albania
| | | | | | | | | | | | - Paolo Groff
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania
| | - Miljan Jovic
- General Hospital, Health Centre, Zaječar, Serbia
| | - Òscar Miró
- Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Said Laribi
- Emergency Medicine Department, CHU Tours, Tours University, Tours, France
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