Evaluation of the use and applicability of the ESC 2018 recommendations on risk stratification of syncope in the emergency department

Abstract

Complications related to syncope vary according to its etiology, which remains undetermined in approximately 20% of cases. The use of a risk stratification and patient referral protocol, such as the one proposed in the ESC 2018 recommendations, could be a solution to improve the management of syncope. To evaluate the use of syncope risk stratification protocols in an emergency department. The secondary objective is to evaluate the applicability of the ESC recommendations and their ability to stratify the risk of complications after an episode of syncope. Observational, retrospective, monocentric study conducted in the emergency department of the university hospital of Brest during February 2018 for the reasons “discomfort with or without loss of consciousness”, “chest pain”, “tachycardia”, “bradycardia”, and “suspected pulmonary embolism”. Patients who presented with a real episode of syncope or presyncope were classified into three risk groups (low, intermediate and high) according to the ESC recommendations. In total, 436 patients met the initial search criteria, of which 100 were included. No records mentioned the use of a risk stratification protocol. ESC recommendations were applicable to 87% of the records. Thirty-one percent of patients were classified as low risk, and of these, 3 patients (10%) were rehospitalized or had a complication at 1 year. Twenty-three percent of the patients were classified as intermediate risk, among them 8 patients (35%) were rehospitalized or had a complication at 1 year. Forty-six percent of the patients were at high-risk, among them 23 (50%) were rehospitalized or had a complication at 1 year ( Fig. 1 ). The use of risk stratification protocols for syncope management is not a common practice in the emergency department. According to our study, the ESC recommendations are easily applicable and seem to effectively classify patients into three risk groups. A larger study therefore seems warranted to confirm these findings.