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Approach to syncope in the emergency department
  1. Matthew James Reed1,2
  1. 1 Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2 Acute Care Group, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Matthew James Reed, Emergency Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK; matthew.reed{at}


Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge.

  • emergency department
  • cardiac care, diagnosis

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  • Contributors MJR researched and wrote the article.

  • Funding MR is supported by an NHS Research Scotland Career Researcher Clinician award.

  • Competing interests MJR was a Task Force member for the diagnosis and management of syncope guidelines of the European Society of Cardiology (ESC) published in March 2018. MJR has been supplied with Zio XT monitors and ECG analysis services free of charge for research purposes from iRhythm Technologies between 2015 and 2017. MJR has received funds for consultation from Medtronic in 2018. The Emergency Medicine Research Group Edinburgh has received sponsorship for the EMERGE10 conference in 2018 from various companies including Medtronic, AliveCor and iRhythm Technologies.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.