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European Heart Journal Advance Access published online on August 25, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi474
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received January 10, 2005
Revised July 27, 2005
Accepted August 4, 2005

Clinical research

Hospital admission of patients referred to the Emergency Department for syncope: a single-hospital prospective study based on the application of the European Society of Cardiology Guidelines on syncope

Angelo Bartoletti 1*, Plinio Fabiani 2, Paolo Adriani 3, Francesca Baccetti 3, Luciano Bagnoli 3, Gianluca Buffini 3, Carlo Cappelletti 2, Paolo Cecchini 3, Roberto Gianni 3, Alessandro Lavacchi 3, Pier Francesco Ticali 3, and Giovanni Maria Santoro 4

1 Cardiology Division, Nuovo San Giovanni di Dio Hospital, Florence, Italy; Costa dei Magnoli 28, 50125 Florence, Italy
2 Internal Medicine Department, Nuovo San Giovanni di Dio Hospital, Florence, Italy
3 Emergency Department, Nuovo San Giovanni di Dio Hospital, Florence, Italy
4 Cardiology Division, Nuovo San Giovanni di Dio Hospital, Florence, Italy

* To whom correspondence should be addressed.
Angelo Bartoletti, E-mail: angelobartoletti{at}libero.it


  Abstract

Aims To evaluate the applicability and the clinical impact of the European Society of Cardiology (ESC) Guidelines' recommendations for hospital admission of patients with syncope in a District Hospital Emergency Department (ED).

Methods and results From September 2002 to August 2004, 1124 patients with syncope [out of 1308 with transient loss of consciousness (TLC)] were evaluated according to the ESC Guidelines. Overall, 566 patients with syncope (50.1%) were admitted and 558 (49.9%) were discharged. Out of the 1124 patients with syncope, 440 (39.1%) presented at least one ESC Guidelines' criterion for hospitalization. Out of the 440, 393 (89.3%) were admitted, whereas 511 out of the 684 (74.7%) without indication for admission were discharged. A significant difference was found between the adherence rates for admission and for discharge (P < 0.001). The appropriateness of the ED medical decision was 69.4% for hospital admission and 91.6% for discharge (P < 0.001).

Conclusion Although an acceptable ED adherence to the guidelines' indications was attained, better implementation strategies are still advisable. The ESC Guidelines' indications are applicable to the majority of patients entering the ED for a TLC. In addition, when the guidelines' indications are observed, a high percentage of patients with syncope have still to be hospitalized.

Keywords: Syncope; Guidelines; Transient loss of consciousness.
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