The Management of Syncope in a British Emergency Department Compared to Recent American Guidelines

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Abstract
This descriptive study aims to determine current clinical practice in an emergency department when assessing patients presenting with syncope and then to compare this with recent guidelines from the American College of Physicians. Key points on history, examination, investigation and disposition of patients from the department were measured. Of 100 patients recruited, few had relevant symptoms documented. Seventy-five patients had an electrocardiogram performed, in which 18 were defined as abnormal. 40% of those with a history of organic heart disease were sent home. 28% of those with an abnormal electrocardiogram were discharged. 44% of those aged over 70 were discharged. A total of 45 patients were admitted. An extra 17 to 26 patients may have been admitted if the American guidelines had been adhered to. This study highlights deficiencies in assessment and a difference in current practice when compared with the recommendations from the American College of Physicians. Further research is required to produce guidelines on disposition applicable to emergency departments in the United Kingdom.