Causes and outcome of syncope

Background. Little is known about the frequency of patients presenting to t he emergency department with syncope. Regarding mortality and predictors of outcome the literature remains inconclusive. Aims. The aims of the study were to determine the frequency of patients pre senting with syncope to an emergency department, to assess mortality among these patients and to determine potential predictors of poor outcome. Methods. Data of all consecutive patients who were treated at our emergency department between January Ist 1994 and September Ist 1997 following synco pe were collected retrospectively. The presumptive causes of syncope were c lassified into six categories (cardiogenic, neurogenic, autonomic dysfuncti on, psychiatric, toxic/alcoholic, idiopathic/unexplained). Patients were fo llowed until December 31st, 1997. Results. 701 patients (0.35 % of all emergency department visits) were trea ted for this reason. 507 patients were eligible for the study. During follo w-up 8% (n=38) of the patients died. Three patients died within the first 2 8 days, all with a known severe underlying disease (congestive heart failur e, malignancy, ischemic cerebral infarction). Non-survivors more frequently had a cardiogenic (34%) or neurogenic (13%) cause of syncope (p<0.01). Age >60 years, syncope due to neurogenic cause and abnormal ECG findings were independent predictors of increased mortality. Conclusions. Patients with syncope only comprise a small proportion of thos e seen at the emergency department. Mortality among these patients is 8%. C linical history and ECG findings are major determinants of risk stratificat ion: Age > 60 years, syncope due to neurogenic causes and abnormal ECG are independent predictors of poor outcome.