Syncope - Revision history

Danbot: Add to Category:Symptoms - common EM chief complaint

2026-03-22T09:41:42Z

Add to Category:Symptoms - common EM chief complaint

← Older revision		Revision as of 09:41, 22 March 2026
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	==References==		==References==
	<references/>		<references/>
			[[Category:Symptoms]]
	[[Category:Cardiology]]		[[Category:Cardiology]]

Danbot: Move calculators to own section with header (visible in TOC), expanded, before External Links

2026-03-21T15:07:27Z

Move calculators to own section with header (visible in TOC), expanded, before External Links

← Older revision		Revision as of 15:07, 21 March 2026
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	*Performed poorly on external validation<ref name="Birnbaum">Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52(2):151-9.</ref>		*Performed poorly on external validation<ref name="Birnbaum">Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52(2):151-9.</ref>
	*External validation of San Francisco Syncope Rule showed sensitivity 90% but only specificity of 33% <ref> Thiruganasambandamoorthy et al, External validation of the San Francisco Syncope Rule in the Canadian setting. Ann Emerg Med. 2010 May;55(5):464-72. doi: 10.1016 </ref>		*External validation of San Francisco Syncope Rule showed sensitivity 90% but only specificity of 33% <ref> Thiruganasambandamoorthy et al, External validation of the San Francisco Syncope Rule in the Canadian setting. Ann Emerg Med. 2010 May;55(5):464-72. doi: 10.1016 </ref>

			== Calculators ==
			{{SF_Syncope_Calculator}}

	==External Links==		==External Links==
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	==References==		==References==
	<references/>		<references/>


	~~<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">~~
	~~<div style="font-weight:bold;">📊 San Francisco Syncope Rule Calculator [show]</div>~~
	~~<div class="mw-collapsible-content">~~
	~~{{SF_Syncope_Calculator}}~~
	~~</div>~~
	~~</div>~~
	[[Category:Cardiology]]		[[Category:Cardiology]]

Danbot: Add San Francisco Syncope Rule calculator (collapsible)

2026-03-21T13:44:15Z

Add San Francisco Syncope Rule calculator (collapsible)

← Older revision		Revision as of 13:44, 21 March 2026
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	<references/>		<references/>


			<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">
			<div style="font-weight:bold;">📊 San Francisco Syncope Rule Calculator [show]</div>
			<div class="mw-collapsible-content">
			{{SF_Syncope_Calculator}}
			</div>
			</div>
	[[Category:Cardiology]]		[[Category:Cardiology]]

Beren85: /* Discharge */

2022-06-01T14:39:19Z

Discharge

← Older revision		Revision as of 14:39, 1 June 2022
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	*No events on telemetry after period of observation (2-4 hours in the ED)		*No events on telemetry after period of observation (2-4 hours in the ED)
	*Consider referral for holter or til-table test		*Consider referral for holter or til-table test
			*Instruct to avoid precipitating factors, such as extreme heat, dehydration, postexertional standing, alcohol and certain medications

	==Additional Risk Stratification Tools for Selecting Low-Risk patients for Discharge==		==Additional Risk Stratification Tools for Selecting Low-Risk patients for Discharge==

Beren85: /* AdmitHuff JS, Decker WW, Quinn JV et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49(4):431-444 */

2022-06-01T14:37:34Z

AdmitHuff JS, Decker WW, Quinn JV et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49(4):431-444

← Older revision		Revision as of 14:37, 1 June 2022
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	*Evidence of hemorrhage (occult blood)		*Evidence of hemorrhage (occult blood)
	*Syncope without prodrome		*Syncope without prodrome
			*Exertional syncope in younger patients without an obvious benign cause

	===Discharge===		===Discharge===

Rossdonaldson1: /* Differential Diagnosis */

2022-05-14T12:37:32Z

Differential Diagnosis

← Older revision		Revision as of 12:37, 14 May 2022
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	==Differential Diagnosis==		==Differential Diagnosis==

	{{Syncope causes}}		{{Syncope causes}}

Masoodrm: /* Differential Diagnosis */

2022-05-06T17:06:54Z

Differential Diagnosis

← Older revision		Revision as of 17:06, 6 May 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
	*''[[Seizure]]''

	{{Syncope causes}}		{{Syncope causes}}

Hoxbox at 11:53, 21 May 2020

2020-05-21T11:53:58Z

← Older revision		Revision as of 11:53, 21 May 2020
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	Canadian Syncope Risk Score to predict serious adverse		Canadian Syncope Risk Score to predict serious adverse
	events after emergency department assessment of syncope.		events after emergency department assessment of syncope.
	CMAJ. 2016 Sep 6;188(12):E289-E298.</ref>===		CMAJ. 2016 Sep 6;188(12):E289-E298.</ref> [https://www.mdcalc.com/canadian-syncope-risk-score MDCalc]===
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|'''Category'''		\| align="center" style="background:#f0f0f0;"\|'''Category'''
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	*Score < 0 associated with < 2% risk of serious adverse event at 30 days.		*Score < 0 associated with < 2% risk of serious adverse event at 30 days.
	*Externally validated per data presented at SAEM 2018.		*Externally validated per data presented at SAEM 2018 and only 0.3% 30 day adverse events for very low risk patients in 2020 Jama study <ref>Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. JAMA Intern Med. 2020 Mar 23. https://doi.org/10.1001/jamainternmed.2020.0288 </ref>

	===[[EBQ: San Francisco Syncope Rule \| San Francisco Syncope Rule]]===		===[[EBQ: San Francisco Syncope Rule \| San Francisco Syncope Rule]]===

Gpowellhb: /* Work-Up */

2020-02-20T19:18:43Z

Work-Up

← Older revision		Revision as of 19:18, 20 February 2020
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	**Part of [[Choosing wisely ACEP]]		**Part of [[Choosing wisely ACEP]]
	*Does [[Pulmonary Embolism (PE)\|PE]] need to be worked up?		*Does [[Pulmonary Embolism (PE)\|PE]] need to be worked up?
	**NEJM paper by Prandoni<ref>Prandoni P, Lensing AW, Prins MH, Ciammaichella M, Perlati M, Mumoli N, Bucherini E, Visonà A, Bova C, Imberti D, Campostrini S, Barbar S; PESIT Investigators. Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med. 2016 Oct 20;375(16):1524-1531. PubMed PMID: 27797317.</ref> showed 3.8% of admitted ~~ED pts with~~ syncope had PE		**NEJM paper by Prandoni<ref>Prandoni P, Lensing AW, Prins MH, Ciammaichella M, Perlati M, Mumoli N, Bucherini E, Visonà A, Bova C, Imberti D, Campostrini S, Barbar S; PESIT Investigators. Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med. 2016 Oct 20;375(16):1524-1531. PubMed PMID: 27797317.</ref> showed that 7.14% of patients admitted for syncope had a pulmonary embolism and of the cohort that were not low risk with a negative d-dimer, the risk was as high as 17.3%
	**2018 systematic reviewed <ref>Prevalence Of Pulmonary Embolism In Patients Presenting With Syncope: A Systematic Review And Meta-Analysis Oqab, Z., et al, Am J Emerg Med 36(4):551, April 2018</ref> showed 0.8% of admitted ED pts with syncope had PE		**2018 systematic reviewed <ref>Prevalence Of Pulmonary Embolism In Patients Presenting With Syncope: A Systematic Review And Meta-Analysis Oqab, Z., et al, Am J Emerg Med 36(4):551, April 2018</ref> showed 0.8% of admitted ED pts with syncope had PE
			**Also supported by 2019 study showing prevalence of 2.3% in undifferentiated patients admitted with syncope<ref>Prevalence of pulmonary embolism in patients with syncope Badertscher P, du Fay de Lavallaz J, Hammerer-Lercher A, et al. J Am Coll Cardiol. 2019;74(6):744-754.</ref>.
			**Both of these two studies refute the findings of the PESIT study listed first
	*Bedside [[Ultrasound (main)\|US]]		*Bedside [[Ultrasound (main)\|US]]
	**PSL view may show thickened ventricular septum		**PSL view may show thickened ventricular septum

Rossdonaldson1: /* Work-Up */

2019-11-28T20:17:08Z

Work-Up

← Older revision		Revision as of 20:17, 28 November 2019
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	*[[CXR]]		*[[CXR]]
	*Orthostatics (symptomatic)		*Orthostatics (symptomatic)
	*[[Guaiac]]		*Guaiac
	*CT scan of head is not recommended in asymptomatic, insignificant trauma with normal neurologic examination		*CT scan of head is not recommended in asymptomatic, insignificant trauma with normal neurologic examination
	**Part of [[Choosing wisely ACEP]]		**Part of [[Choosing wisely ACEP]]
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	*Bedside [[Ultrasound (main)\|US]]		*Bedside [[Ultrasound (main)\|US]]
	**PSL view may show thickened ventricular septum		**PSL view may show thickened ventricular septum
	**High sensitivity to rule out AAA		**High sensitivity to rule out [[AAA]]

	===Diagnosis===		===Diagnosis===