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Syncope

Date Last Search Run: Feb 01, 2022
Table last updated: Sep 29, 2022
Data last added: Sep 10, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

12-Lead ECG
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Serious adverse outcome at 30 days. Patient Gibson TA, Weiss RE, Sun BC. Predictors of Short-Term Outcomes after Syncope: A Systematic Review and Meta-Analysis. The western journal of emergency medicine 2018; 19(3):517-23. Medline
II Supportive (Green) Risk classification Process ED-MD Colivicchi F., Ammirati F., Melina D., et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: The OESIL risk score. Eur Heart J 2003; 24(9):811-9. Medline
II Supportive (Green) Serious Adverse Events Patient Cook OG., Mukarram MA., Rahman OM., Kim SM., Arcot K., Thavorn K., et al. Reasons for Hospitalization Among Emergency Department Patients With Syncope. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2016;23(11):1210-7. Medline
II Supportive (Green) 30 day mortality Patient PH-Paramedic Sato N, Minami Y, Ako J, Maeda A, Akashi Y, Ikari Y, et al. Clinical significance of prehospital 12-lead electrocardiography in patients with ST-segment elevation myocardial infarction presenting with syncope: from a multicenter observational registry (K-ACTIVE study). Heart Vessels 2021. Medline
III Supportive (Green) Factors associated with Mortality, Hospitalization, Intervention Patient ED-MD D'Ascenzo F., Biondi-Zoccai G., Reed MJ., et al. Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the emergency department with syncope: An international meta-analysis. Int J Cardiol 2013; 167(1):57-62. Medline
III Supportive (Green) Syncope management Process ED-MD Elesber AA., Decker WW., Smars PA., Hodge DO., Shen WK., American College of Emergency Physicians. Impact of the application of the american college of emergency physicians recommendations for the admission of patients with syncope on a retrospectively studied population presenting to the emergency department. Am Heart J 2005; 149(5):826-31. Medline
III Supportive (Green) Prevalence of acute cardiac ischemia Process ED-MD Georgeson S., Linzer M., Griffith JL., Weld L., Selker HP. Acute cardiac ischemia in patients with syncope: Importance of the initial electrocardiogram. J Gen Intern Med 1992; 7(4):379-86. Medline
III Supportive (Green) prediction of Hyperkalaemia Process PH-Paramedic Taxel S, Holtz M. Mysterious Weakness: Life-threatening condition can be managed in the field. JEMS 2017; 42(4):18-21. Medline
III Neutral (Yellow) Mortality Process ED-MD Perez-Rodon J., Martinez-Alday J., Baron-Esquivias G., et al. Prognostic value of the electrocardiogram in patients with syncope: Data from the group for syncope study in the emergency room (GESINUR). Heart Rhythm 2014; 11(11):2035-44. Medline

Clinical Decision Making Rule
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Risk classification Process ED-MD Colivicchi F., Ammirati F., Melina D., et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: The OESIL risk score. Eur Heart J 2003; 24(9):811-9. Medline
II Supportive (Green) Adverse event post discharge Patient ED-MD Muhtaseb O, EA A, SA G. A Tale of Two Cities: Applying the Boston Syncope Criteria to Jerusalem. Isr Med Assoc J 2021; 23(7):420–5. Medline
II Supportive (Green) 30-day outcome; risk stratification tool accuracy Patient ED-MD Sweanor RAL, Redelmeier RJ, Simel DL , Albassam OT, Shadowitz S , Etchells EE. Multivariable risk scores for predicting short-term outcomes for emergency department patients with unexplained syncope: A systematic review. Acad Emerg Med 2021; 28(5):502–10. Medline
II Neutral (Yellow) Death within 30 days, Serious outcomes Patient ED-MD Costantino G., Casazza G., Reed M., et al. Syncope risk stratification tools vs clinical judgment: An individual patient data meta-analysis. Am J Med 2014; 127(11):1126.e13-25. Medline
II Neutral (Yellow) MACE and Death at 2 years Patient ED-MD du Fay de Lavallaz J, Badertscher P, Nestelberger T, Isenrich R, Miró Ò, Salgado E, et al. Prospective validation of prognostic and diagnostic syncope scores in the emergency department. Int J Cardiol 2018; 269:114-21. Medline
II Neutral (Yellow) Sensitivity and Specificity Process ED-MD Serrano LA., Hess EP., Bellolio MF., et al. Accuracy and quality of clinical decision rules for syncope in the emergency department: A systematic review and meta-analysis. Ann Emerg Med 2010; 56(4):362-373. Medline
II Neutral (Yellow) Serious adverse event within 30 days Patient Thiruganasambandamoorthy V., Kwong K., Wells GA., Sivilotti ML., Mukarram M., Rowe BH., et al. Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2016;188(12):E289-98. Medline
III Supportive (Green) Composite of mortality or arrhythmia Patient Thiruganasambandamoorthy V., Stiell IG., Sivilotti MLA., Rowe BH., Mukarram M., Arcot K., et al. Predicting Short-term Risk of Arrhythmia among Patients With Syncope: The Canadian Syncope Arrhythmia Risk Score. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2017;24(11):1315-26. Medline
III Neutral (Yellow) Ability of CSRS to discriminate between cardiac and non-cardiac syncope Process ED-MD Safari S, Khasraghi ZS, Chegeni MA, Ghabousian A, Amini A. The ability of Canadian Syncope risk score in differentiating cardiogenic and non-cardiogenic syncope; a cross-sectional study. Am J Emerg Med 2021; 50:675–8. Medline

Oxygen
Level Direction Primary Outcome Patient/Process Setting Reference

Physical counterpressure manuvers
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Prevention Patient SIM Jensen JL, Ohshimo S, Cassan P, Meyran D, Greene J, Ng KC, Singletary E, Zideman D; First Aid and Pediatric Task Forces of the International Liaison Committee on Resuscitation. Immediate Interventions for Presyncope of Vasovagal or Orthostatic Origin: A Systematic Review. Prehosp Emerg Care. 2019. [Epub ahead of print] Medline


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