Syncope is defined as a transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness.
Syncope is a prevalent disorder, accounting for 1-3% of emergency department (ED) visits and as many as 6% of hospital admissions each year in the United States. As much as 50% of the population may experience a syncopal event during their lifetime. Although many etiologies for syncope are recognized, categorization into reflex (neurally mediated), orthostatic, and cardiac (cardiovascular) may be helpful during the initial evaluation. Cardiac syncope is associated with increased mortality, whereas noncardiac syncope is not. Syncope may result in significant morbidity due to falls or accidents that occur as a result. In the United States alone, an estimated $2 billion annually is spent on patients hospitalized with syncope.
Although most causes of syncope are benign, this symptom presages a life-threatening event in a small subset of patients. It is unclear whether hospital inpatient admission of asymptomatic patients after syncope affects outcomes. No current criterion standard exists for diagnosing undifferentiated syncope. Many physicians continue to admit patients because of perceived risk. Recent reviews of the 2001 American College of Emergency Physician (ACEP) clinical policy suggest that evidence-based criteria may decrease admission rates by nearly half by identifying cardiac causes of syncope. Inpatient admission should be reserved for patients in whom identification of specific immediate risk, such as those with structural heart disease or history of ventricular arrhythmia, is needed. Outpatient management can be used for patients who are low risk for a cardiac etiology in order to define a precise cause in order to effect mechanism-specific treatment.