Do patients with a negative Emergency Department evaluation for syncope require hospital admission?

Is hospitalization needed for patients in whom an underlying cause of syncope is not detected in the Emergency Department (ED)? To answer this question, we conducted a prospective, short-term outcomes study of consecutive patients > or = 50 years old presenting to our ED after a syncopal episode. All subjects received a structured ED evaluation. Forty-five patients met inclusion criteria, 67% were hospitalized. None of the patients experienced a life-threatening event or required significant therapeutic interventions during the hospitalization. No patient had a new diagnosis relevant to syncope. Follow-up interviews 1 month later revealed no repeat ED visits, hospitalizations, or deaths (95% upper CI, 6.5%). One patient reported a recurrent syncope (recurrence 2.2% [95% upper CI, 10%]). This pilot study suggests that a negative structured ED evaluation may identify patients > or = 50 years of age who may be safely discharged from the ED. Further validation is required before this observation is applied to clinical practice.