Grant: Operating Grant

Syncope (fainting) is a common problem in the emergency department (ED). Annually about 100,000 patients visit Canadian emergencies and about 10,000 of them will have serious underlying problems such as blood clots in the lung (pulmonary embolism), heart attack, or irregular heart rhythm requiring pacemaker/defibrillator, or will die. About half of these conditions are not evident during the ED visit. Because of a significant shortage of hospital beds, most patients will be discharged home including one-third with serious conditions. Among those who die after the ED visit; two-thirds will die outside the hospital. There is little evidence to guide emergency physicians to risk-stratify ED syncope patients. A previous study conducted by our team showed that it is feasible to identify those at risk for serious events. The goal of this study is to develop a decision tool to accurately risk-stratify adult ED syncope patients for serious events after ED discharge. We are presently conducting a pilot study and with funding from this application, we intend to enroll a total of 4,000 consenting syncope patients at six Canadian EDs. We will collect patient characteristics, medical information and test results. Treatment will not differ for enrolled patients. We will conduct a 30-day telephone follow-up to assess for occurrence of serious events. Based on the information collected, we will develop a new risk scale to risk-stratify patients as low-risk who can be discharged; medium-risk who need urgent specialist follow-up and high-risk who need to be admitted. We will undertake subsequent research to validate this decision tool. This tool will help emergency doctors, cardiologists, neurologists, medicine specialists and family doctors to improve and standardize the care of syncope patients; improve patient safety by admitting those at risk; and help doctors quickly decide treatment thereby improve emergency wait times.