Syncope risk assessment in the emergency department and clinic.

The initial assessment of patients who present with presumed syncope is challenging. Syncope has many possible causes ranging from relatively benign to potentially life-threatening, and sorting through the possibilities may not be feasible given time limitations in an urgent care setting. Therefore, the physician almost always must determine whether the affected individual needs in-hospital evaluation or can be safely referred to an outpatient syncope evaluation clinic. In instances when the etiology of syncope has been diagnosed with confidence at the initial clinical evaluation, the hospitalization question is readily addressed and the appropriateness of hospitalization versus timely outpatient evaluation (preferably in a dedicated syncope management clinic) is clear. In those cases in which the diagnosis is uncertain, risk stratification schemes such as those summarized in this communication become more essential. However, at present no single risk assessment protocol appears to be satisfactory for universal application. The development of a consensus recommendation is an essential next step.