Guidelines
Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017 Aug 1;136(5)–122. doi: 10.1161/CIR.0000000000000499. Epub 2017 Mar 9. Erratum in: Circulation. 2017 Oct 17;136(16)–2. PMID: 28280231.
Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883–1948. doi: 10.1093/eurheartj/ehy037. PMID: 29562304.
Möckel M, Janssens KAC, Pudasaini S, Garcia-Castrillo Riesgo L, Moya Torrecilla F, Golea A, et al. The syncope core management process in the emergency department: a consensus statement of the EUSEM syncope group. Eur J Emerg Med. 2024 Aug 1;31(4):250–259. doi: 10.1097/MEJ.0000000000001146. Epub 2024 Jun 13. PMID: 38874507; PMCID: PMC11198953.
Studies on incidence
Ganzeboom KS, et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol. 2006 Nov;17(11):1172-6. PMID: 17074006.
Reed MJ, et al. Management of syncope in the Emergency Department: a European prospective cohort study (SEED). Eur J Emerg Med. 2024 Apr 1;31(2):136-146.
Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa012407
Lopez Ayala P, Flores D, Zimmermann T, Du Fay De Lavallaz J, Nestelberger T, Strebel I, et al. Incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope. Eur Heart J. 2020 Nov 1;41(Supplement_2). Available from: https://dx.doi.org/10.1093/ehjci/ehaa946.0364
D’Ascenzo F, BZ G, Rizzello M, Gaita G, Sestito G, Caiazzo G, 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 Jul 15;167(1):57–62. Available from: https://pubmed.ncbi.nlm.nih.gov/22192287
Studies on outcome
Thiruganasambandamoorthy V, Yan JW, Reed BH, Émond M, Lee S, Hess M, et al. Personalized risk prediction following emergency department assessment for syncope. Emerg Med J. 2022 Jul;39(7):534-40. Available from: https://pubmed.ncbi.nlm.nih.gov/34740890
Kiradoh S, Chan TE, Mo R, Nanda LM, Zakhar E, Shum S, et al. Predicting short-term adverse outcomes in the geriatric population presenting with syncope: a comparison of existing syncope rules and beyond. J Geriatr Cardiol. 2023 Jan 28;20(1):19-27. Available from: https://pubmed.ncbi.nlm.nih.gov/36875169
Gabayan GZ, Derose SF, Chiu VY, Sun BC. Patterns and preexisting risk factors of 30‐day mortality after a primary discharge diagnosis of syncope or near syncope. Acad Emerg Med. 2012 Aug;19(8):897-903. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2012.01336.x
Toarta C, Mukarram M, Khan SM, Greenberg S, Stiell M, et al. Syncope prognosis based on emergency department diagnosis: a prospective cohort study. Acad Emerg Med. 2018 Apr;25(4):388-96. Available from: https://pubmed.ncbi.nlm.nih.gov/29136314
Differentiating syncope from other forms of transient loss of consciousness
Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA. Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol. 2002 Jul 3;40(1):142–8.
Symptomatic syncope - Pulmonary Embolism
Kelly C, Brown Jr S, White SC, Sheldon SM, Brown Jr J, Brown AM, et al. Diagnostic yield of pulmonary embolism testing in patients presenting to the emergency department with syncope. Res Pract Thromb Haemost. 2019 Dec 26;4(2):250–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32110757
Raj P, Chang MC, Teeter J, Da Prado C, Farias AL, Guilmette HG, et al. Prevalence of pulmonary embolism in emergency department patients with isolated syncope: A prospective cohort study. Eur J Emerg Med. 2019 Dec;26(6):404-11. Available from: https://pubmed.ncbi.nlm.nih.gov/31609876
Oqab Z, Ganshorn H, Sheldon R. Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. Am J Emerg Med. 2018 Apr;36(4):551–5.
Keller K, Lankeit M, Tzikas A, Zeymer U, Konstantinides S, et al. Syncope in hemodynamically stable and unstable patients with acute pulmonary embolism - Results of the German nationwide inpatient sample. Sci Rep. 2018 Oct 25;8(1):15187. Available from: https://pubmed.ncbi.nlm.nih.gov/30361542
De Winter M, Van Beek EdP, Koopman PM, Kaasjager KA, Huisman MV, Nijkeuter M. The prognostic value of syncope on mortality in patients with pulmonary embolism: A systematic review and meta-analysis. Ann Emerg Med. 2020 Oct;76(4):480-9. Available from: https://pubmed.ncbi.nlm.nih.gov/32461009
Symptomatic syncope - Aortic dissection
Howard KM, Sundt CE, Ehlert KA, Hagberg AT, Isselbacher EM, Trimarchi T, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation [Internet]. 2011 Jan 11 [cited 2024 Oct 3];124(18):1911-8. Available from: https://pubmed.ncbi.nlm.nih.gov/21969019/
Morello F, Spinoni MS, Forte AT, Garrubba S, Nardelli P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med [Internet]. 2021 Jan [cited 2024 Jun 23];16(1):123-31. Available from: https://pubmed.ncbi.nlm.nih.gov/32358680/
Rogers C, Lawler S, Graziano M, Ball E, Tartara F, Callow RM, et al. Risk factors for diagnostic delay in acute aortic dissection. Am J Cardiol [Internet]. 2008 Nov 15 [cited 2024 Oct 3];102(10):1399-402. Available from: https://pubmed.ncbi.nlm.nih.gov/18993163/
Symptomatic syncope - Other
D'Ascenzo F, Biondi-Zoccai G, Reed MJ, Gabayan GZ, Sicari R, Jang WJ, 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 Jul 15;167(1):57-62.
Suwatcharangkoon S, Meyers E, Falo C, Schmidt JM, Agarwal S, Claassen J, et al. Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury. JAMA Neurol. 2016 Jan;73(1):28-35.
The Canadian Syncope Risk Score
Original study
Thiruganasambandamoorthy V, Stiell IG, Wells GA, Sivilotti ML, Rowe BH, Mukarram M, et al. Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope. CMAJ. 2016 Aug 9;188(12). doi: 10.1503/cmaj.151469. PMID: 27503852; PMCID: PMC4981295.
Validation studies
Thiruganasambandamoorthy V, Kwong K, Wells GA, Sivilotti ML, Mukarram M, Rowe BH, et al. Accuracy of the Canadian Syncope Risk Score in the Emergency Department for Patients With Syncope: A Multicenter Prospective Cohort Study. Ann Emerg Med. 2020 Mar;75(3):456-466. doi: 10.1016/j.annemergmed.2019.08.422. PMID: 31685291.
Costantino G, Perego F, Dipaola F, Borella M, Galli A, Cantoni G, et al. Validation of the Canadian Syncope Risk Score for predicting adverse outcomes in patients with syncope: a multicentre prospective cohort study. Emerg Med J. 2020 Apr;37(4):259-265. doi: 10.1136/emermed-2019-208575. PMID: 32111635.
Thiruganasambandamoorthy V, Kwong K, Wells GA, Mukarram M, Rowe BH, Sivilotti ML, et al. External validation of the Canadian Syncope Risk Score for patients presenting to emergency departments with syncope. JAMA Intern Med. 2020 May 1;180(5):737-744. doi: 10.1001/jamainternmed.2020.0286. PMID: 32293572.
Sun BC, Thiruganasambandamoorthy V, Cruz MP, Creatore M, Mukarram M, Wells GA, et al. External validation of the Canadian Syncope Risk Score and derivation of the FAINT rule for syncope. Acad Emerg Med. 2020 Oct;27(10):1012-1021. doi: 10.1111/acem.14075. PMID: 32367564.
Brain D, Arulanandam Y, Dayananda M, Barnes E, Hunt J, Hilton J, et al. Economic evaluation of applying the Canadian Syncope Risk Score in an Australian emergency department. Emerg Med Australas [Internet]. 2023 Jun [cited 2024 Jun 23];35(3):361-367. Available from: https://pubmed.ncbi.nlm.nih.gov/36403945/
Chan J, Hunt J, Dayananda M, Barnes E, Brown D, Arulanandam Y, et al. Evaluating patients presenting to the emergency department after syncope: validation of the Canadian Syncope Risk Score. Med J Aust [Internet]. 2019 Jun [cited 2024 Jun 28];210(11):508-514. Available from: https://pubmed.ncbi.nlm.nih.gov/31066057/
Chan J, Barnes E, Brown D, Hunt J, Arulanandam Y, Dayananda M, et al. External validation of the Canadian Syncope Risk Score for patients presenting with undifferentiated syncope to the emergency department. Emerg Med Australas [Internet]. 2021 Jun [cited 2024 Jun 23];33(3):419-426. Available from: https://pubmed.ncbi.nlm.nih.gov/33052034/
Zimmermann Z, Du Fay de Lavallaz J, Nestelberger T, Gekeler D, Lopez Ayala P, Boeddinghaus J, et al. International Validation of the Canadian Syncope Risk Score: A Cohort Study. Ann Intern Med [Internet]. 2022 Jun [cited 2024 Jul 28];175(6):777-785. Available from: https://pubmed.ncbi.nlm.nih.gov/35467933/
Thiruganasambandamoorthy V, Sivilotti MLA, Le Sage N, Yan JW, Huang P, Hewin M, et al. Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. JAMA Intern Med [Internet]. 2020 Jan 5 [cited 2024 Jan 31];180(5):737-744. Available from: https://pubmed.ncbi.nlm.nih.gov/32202605/
Solbiati M, Talerico G, Villa P, Dipaola F, Furlan R, Furlan L, et al. Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement. Emerg Med J. 2021 Sep 1;38(9):701-706. Available from: https://pubmed.ncbi.nlm.nih.gov/34099462/
Zimmermann T, Du Fay De Lavallaz J, Florez D, Widmer V, Freese M, Walter J, et al. Validation of the Canadian syncope risk score in a large prospective international multicenter study. Eur Heart J [Internet]. 2020 Nov 1 [cited 2024 Jul 28];41(Supplement_2).0701. Available from: https://dx.doi.org/10.1093/ehjci/ehaa946.0701