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2015 ; 15
(2
): 103-9
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English Wikipedia
Syncope: Assessment of risk and an approach to evaluation in the emergency
department and urgent care clinic
#MMPMID26937094
Akdemir B
; Krishnan B
; Senturk T
; Benditt DG
Indian Pacing Electrophysiol J
2015[Mar]; 15
(2
): 103-9
PMID26937094
show ga
Syncope is among the most frequent forms of transient loss of consciousness
(TLOC), and is characterized by a relatively brief and self-limited loss of
consciousness that by definition is triggered by transient cerebral
hypoperfusion. Most often, syncope is caused by a temporary drop of systemic
arterial pressure below that required to maintain cerebral function, but brief
enough not to cause permanent structural brain injury. Currently, approximately
one-third of syncope/collapse patients seen in the emergency department (ED) or
urgent care clinic are admitted to hospital for evaluation. The primary objective
of developing syncope/TLOC risk stratification schemes is to provide guidance
regarding the immediate prognostic risk of syncope patients presenting to the ED
or clinic; thereafter, based on that risk assessment physicians may be better
equipped to determine which patients can be safely evaluated as outpatients, and
which require hospital care. In general, the need for hospitalization is
determined by several key issues: i) the patient's immediate (usually considered
1 week to 1 month) mortality risk and risk for physical injury (e.g., falls
risk), ii) the patient's ability to care for him/herself, and iii) whether
certain treatments inherently require in-hospital initiation (e.g., pacemaker
implantation). However, at present no single risk assessment protocol appears to
be satisfactory for universal application, and development of a consensus
recommendation is an essential next step.