Syncope: To admit or not to admit

Syncope is one element of the broader issue of 'transient loss of consciousness', but is nevertheless a very common clinical problem. Emergency department physicians and general practitioners are often the first physicians to evaluate the patient. After ensuring that any serious injury is treated, the most important task is to decide whether to admit patients to hospital. Physicians usually take the 'safe' approach and, as a result, admit both high- and intermediaterisk patients to hospital. This is understandable, but has implications for both the patient and for the management of the healthcare system. The European Society of Cardiology guidelines and several clinical studies provide helpful advice regarding 'risk stratification' of patients for hospital admission versus discharge from the emergency department or clinic with subsequent outpatient subspeciality evaluation. Syncope management units and a guideline-based approach tend to reduce the number of undiagnosed cases and the hospital admission rate. This review describes this approach for managing these patients effectively.