{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T19:31:44Z","timestamp":1783711904585,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,1,11]],"date-time":"2018-01-11T00:00:00Z","timestamp":1515628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000241","name":"Physicians' Services Incorporated Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000241","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>visit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively enrolled adult syncope patients at six<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s and excluded patients with presyncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics,<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other\/unknown) at the end of the<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>visit, and physicians\u2019 confidence in assigning the etiology were collected. Serious outcomes at 30\u00a0days included death, arrhythmia, myocardial infarction, structural heart disease, pulmonary embolism, and hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 5,010 patients (mean\u00a0\u00b1\u00a0<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>age\u00a0= 53.4\u00a0\u00b1\u00a023.0 years; 54.8% females) were enrolled; 3.5% suffered serious outcomes\u2014deaths (0.3%), arrhythmias (1.8%), nonarrhythmic cardiac (0.5%), and noncardiac (0.9%) including pulmonary embolism (0.2%). The cause of syncope was presumed as vasovagal among 53.3% and cardiac in 5.4% of patients. The proportion of patients with<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>investigations (p\u00a0&lt;\u00a00.001) and short\u2010term serious outcomes (p\u00a0&lt;\u00a00.01) increased in each diagnostic category in the following order: presumed vasovagal, orthostatic hypotension, other\/unknown cause, and cardiac. No deaths occurred in patients with presumed vasovagal syncope. A higher proportion of all serious outcomes occurred among patients suspected of cardiac syncope in the<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>(p\u00a0&lt;\u00a00.01). Confidence was highest among physicians for a presumed vasovagal syncope diagnosis and lowest when the cause was other\/unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Short\u2010term serious outcomes strongly correlated with the etiology assigned in the<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>visit. The importance of the physician's clinical judgment should be further studied to determine if it should become incorporated in risk\u2010stratification tools for prognostication and safe management of<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>syncope patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13346","type":"journal-article","created":{"date-parts":[[2017,11,14]],"date-time":"2017-11-14T16:22:40Z","timestamp":1510676560000},"page":"388-396","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Syncope Prognosis Based on Emergency Department Diagnosis: A Prospective Cohort Study"],"prefix":"10.1111","volume":"25","author":[{"given":"Cristian","family":"Toarta","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine University of Toronto Toronto Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Mukarram","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital Ottawa Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirtana","family":"Arcot","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital Ottawa Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo\u2010Min","family":"Kim","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital Ottawa Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gaudet","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital Ottawa Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco L.\u00a0A.","family":"Sivilotti","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and the Department of Biomedical and Molecular Sciences Queen's University Kingston Ontario"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian H.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and School of Public Health University of Alberta Edmonton Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh","family":"Thiruganasambandamoorthy","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital Ottawa Ontario"},{"name":"Department of Emergency Medicine and the Department of Epidemiology and Community Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,1,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp298"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.04.030"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2001.2975"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2004.05.032"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(03)00823-0"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2014.11.001"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(82)90913-5"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00797-5"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eupc.2004.08.008"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1016\/j.hrthm.2015.07.021","article-title":"To the Editor\u2010History taking as a diagnostic test in patients with vasovagal syncope","volume":"12","author":"Wieling W","year":"2015","journal-title":"Heart Rhythm"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.2014.0097"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2012.01375.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00319709"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012407"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199005000-00004"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198307283090401"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1540-8167.2007.00984.x","article-title":"High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: the Fainting Assessment 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