The Emergency Department Approach to Syncope: Evidence-based Guidelines and Prediction Rules - 21/08/11

Doi : 10.1016/j.emc.2010.03.014

Chad Kessler, MD ^a,^b,^c,^d,^⁎ , Jenny M. Tristano, MD ^e, Robert De Lorenzo, MD, MSM ^f,^g
^a Department of Emergency Medicine, Jesse Brown VA Hospital, 820 South Damen Avenue, MC 111, Chicago, IL 60612, USA
^b Department of Internal Medicine, The University of Illinois School of Medicine at Chicago, 840 South Wood Street (M/C 718), Chicago, IL 60612-7315, USA
^c Department of Emergency Medicine, The University of Illinois School of Medicine at Chicago, 808 South Wood Street, M/C 724, Chicago, IL 60612, USA
^d Combined Internal Medicine/Emergency Medicine Residency, The University of Illinois School of Medicine at Chicago, 808 South Wood Street, M/C 724, Chicago, IL 60612, USA
^e Departments of Internal Medicine and Emergency Medicine Residency Program, University of Illinois-Chicago, 808 South Wood Street, M/C 724, Chicago, IL 60612, USA
^f Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA
^g Department of Clinical Investigation, MCHE-CI, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200, USA

Corresponding author. Emergency Medicine, Jesse Brown VA Hospital, 820 South Damen Avenue, MC 111, Chicago, IL 60612.

Résumé

Syncope is a sudden, transient loss of consciousness associated with inability to maintain postural tone followed by spontaneous recovery and return to baseline neurologic status. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients whose syncope is a symptom of a potentially life-threatening condition. This article reviews the current status of syncope from the emergency department perspective, focusing on the current evidence behind the various clinical decision rules derived during the past decade.

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Keywords : Syncope, Emergency department, Guidelines, San Francisco Syncope Rule