The Incidence and Outcomes of Adult Syncope Presentations to Emergency Medical Services A Systematic Review
Article Sidebar
Main Article Content
Abstract
Objective: The objectives of this systematic review were to evaluate the incidence, patient demographics and associated outcomes of adult syncope presentations to emergency medical services (EMS) within current literature.
Methods: Inclusion criteria were contact with an EMS, a provisional diagnosis of syncope and epidemiological data regarding EMS contact with these patients. Exclusion criteria were all non-primary studies, patients given an alternative provisional diagnosis or who received life supporting interventions, studies that examined only presyncope presentations or were limited to paediatric patients, or that examined syncope within highly specific non-generalisable settings. Databases were searched on April 5th, 2022, and included Emcare, AMED, Medline, and CINAHL Plus. Quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tool. Data were manually extracted and collated with results synthesised using descriptive statistics and a narrative synthesis.
Results: 12 studies were included in this review. Studies were primarily completed in Europe or the USA, and sample sizes ranged from 500 to 16 million. Most studies were rated as good to fair in quality. No studies specifically looked at the incidence or outcomes of syncope presentations to EMS. The reported incidence of syncope ranged between 0.09% and 24%.
Discussion: Most studies were generalised epidemiological studies looking at EMS presentations. There were no studies that specifically looked at the incidence and outcomes of syncope presentations to EMS together. Instead, they were either large scale epidemiological studies that lack detailed analysis or had small samples focusing only on certain patient characteristics or presentations. An improved understanding of the epidemiological features of syncope presentations within the prehospital setting and their associated outcomes are of critical importance for the determination of risk stratification that can help guide clinical decision making by EMS.
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Publishing in IJOP allows authors to keep their copyright while giving IJOP unrestricted copyright permissions. Articles published in IJOP use Creative Common Attribution 4.0 International (CC BY-ND 4.0) licensing. This license requires that re-users give credit to the creator. It allows re-users to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes. Additional terms apply and can be accessed here.
Publishing in IJOP also allows authors to have contracts for non-exclusive distribution of the Journal's published version of the article, such as posting to an institutional repository or publication in a book, on the condition that the original publication in the original layout format in IJOP is retained and acknowledged.
We permit and encourage authors to post the articles they published in IJOP on their affiliated websites. This helps share the information, encourages citation in other works, and promotes scholarly discourse in the spirit of open access.
References
Alrazeeni, D. M., Sheikh, S. A., Mobrad, A., Al Ghamdi, M., Abdulqader, N., Al Gadgab, M., . . . Al Khaldi, B. (2016). Epidemiology of non-transported emergency medical services calls in Saudi Arabia. Saudi medical journal, 37(5), 575-578. https://doi.org/10.15537/smj.2016.5.13872
Anand, V., Benditt, D. G., Adkisson, W. O., Garg, S., George, S. A., & Adabag, S. (2018). Trends of hospitalizations for syncope/collapse in the United States from 2004 to 2013–An analysis of national inpatient sample. Journal of Cardiovascular Electrophysiology, 29(6), 916-922. https://doi.org/10.1111/jce.13479
Bernier, R., Tran, D. T., Sheldon, R. S., Kaul, P., & Sandhu, R. K. (2020). A Population-Based Study Evaluating Sex Differences in Patients Presenting to Emergency Departments With Syncope. JACC. Clinical Electrophysiology, 6(3), 341-347. https://doi.org/10.1016/j.jacep.2019.11.002
Brain, D., Yan, A., Morel, D., Ballard, E., Hunter, J., Hocking, J., & Chan, J. (2023). Economic evaluation of applying the Canadian Syncope Risk Score in an Australian emergency department. Emergency Medicine Australasia, 35(3), 427-433. https://doi.org/10.1111/1742-6723.14139
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., . . . van Dijk, J. G. (2018). 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal, 39(21), 1883-1948. https://doi.org/10.1093/eurheartj/ehy037
Brunetti, N. D., De Gennaro, L., Dellegrottaglie, G., Antonelli, G., Amoruso, D., & Di Biase, M. (2012). Prevalence of cardiac arrhythmias in pre-hospital tele-cardiology electrocardiograms of emergency medical service patients referred for syncope. Journal of Electrocardiology, 45(6), 727-732. https://doi.org/10.1016/j.jelectrocard.2012.07.018
Cosgriff, T. M., Kelly, A. M., & Kerr, D. (2007). External validation of the San Francisco Syncope Rule in the Australian context. Cjem, 9(3), 157-161. https://doi.org/10.1017/s1481803500014986
Cwinn, A. A., Dinerman, N., Pons, P. T., & Marlin, R. (1988). Prehospital care at a major international airport. Annals of emergency medicine, 17(10), 1042-1048. https://doi.org/10.1016/s0196-0644(88)80442-6
Duong, H. V., Herrera, L. N., Moore, J. X., Donnelly, J., Jacobson, K. E., Carlson, J. N., . . . Wang, H. E. (2018). National Characteristics of Emergency Medical Services Responses for Older Adults in the United States. Prehospital Emergency Care, 22(1), 7-14. https://doi.org/10.1080/10903127.2017.1347223
Ebben, R. H. A., Castelijns, M., Frenken, J., & Vloet, L. C. M. (2019). Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands. World Journal of Emergency Medicine, 10(4), 239-243. https://doi.org/10.5847/wjem.j.1920-8642.2019.04.008
Haddaway, N. R., Grainger, M. J., & Gray, C. T. (2021). citationchaser: an R package for forward and backward citations chasing in academic searching (Version 0.0.3). Retrieved from https://github.com/nealhaddaway/citationchaser
Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Systematic Reviews, 18(2), e1230. https://doi.org/10.1002/cl2.1230
Health, N. I. o. (2013, July, 2021). Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Retrieved from https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
Innovation, V. H. (2022). Covidence systematic review software (Version v2859 85cde2b3 ). Melbourne, Australia. Retrieved from http://www.covidence.org/
Long, B. J., Serrano, L. A., Cabanas, J. G., & Bellolio, M. F. (2016). Opportunities for Emergency Medical Services (EMS) Care of Syncope. Prehospital & Disaster Medicine, 31(4), 349-352. https://doi.org/10.1017/s1049023x16000376
Munn Z, M. S., Lisy K, Riitano D, Tufanaru C. Chapter 5: Systematic reviews of prevalence and incidence. In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020. https://doi.org/10.46658/JBIMES-20-06.
Olaussen, A., Semple, W., Oteir, A., Todd, P., & Williams, B. (2017). Paramedic literature search filters: optimised for clinicians and academics. BMC Medical Informatics and Decision Making, 17(1), 146. https://doi.org/10.1186/s12911-017-0544-z
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery, 88, 105906. https://doi.org/10.1016/j.ijsu.2021.105906
Schewe, J. C., Kappler, J., Dovermann, K., Graeff, I., Ehrentraut, S. F., Heister, U., . . . Muenster, S. (2019). Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval. Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine, 27(1), 36. https://doi.org/10.1186/s13049-019-0617-34
Somani, R., Baranchuk, A., Guzman, J. C., & Morillo, C. A. (2012). The role of Emergency Medical Services in the assessment and management of syncope. International Journal of Cardiology, 154(3), 368-369. https://doi.org/10.1016/j.ijcard.2011.11.066
Sutton, R., Ricci, F., & Fedorowski, A. (2022). Risk stratification of syncope: Current syncope guidelines and beyond. Autonomic Neuroscience, 238, 102929. https://doi.org/10.1016/j.autneu.2021.102929
Thiruganasambandamoorthy, V., Hess, E. P., Turko, E., Perry, J. J., Wells, G. A., & Stiell, I. G. (2013). Outcomes in Canadian emergency department syncope patients--are we doing a good job? Journal of Emergency Medicine, 44(2), 321-328. https://doi.org/10.1016/j.jemermed.2012.06.028
Thiruganasambandamoorthy, V., Sivilotti, M. L. A., Le Sage, N., Yan, J. W., Huang, P., Hegdekar, M., . . . Taljaard, M. (2020). Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. JAMA internal medicine, 180(5), 737-744. https://doi.org/10.1001/jamainternmed.2020.0288
Thiruganasambandamoorthy, V., Stiell, I. G., Sivilotti, M. L. A., Murray, H., Rowe, B. H., Lang, E., . . . Wells, G. A. (2014). Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study. BMC Emergency Medicine, 14(1), 8. https://doi.org/10.1186/1471-227X-14-8
Thiruganasambandamoorthy, V., Taljaard, M., Stiell, I. G., Sivilotti, M. L. A., Murray, H., Vaidyanathan, A., . . . Wells, G. A. (2015). Emergency department management of syncope: need for standardization and improved risk stratification. Internal and Emergency Medicine, 10(5), 619-627. https://doi.org/10.1007/s11739-015-1237-1
Thiruganasambandamoorthy, V., Yan, J. W., Rowe, B. H., Mercier, É., Le Sage, N., Hegdekar, M., . . . Silviotti, M. L. A. (2022). Personalised risk prediction following emergency department assessment for syncope. Emergency Medicine Journal, 39(7), 501. https://doi.org/10.1136/emermed-2020-211095
Ungar, A., Del Rosso, A., Giada, F., Bartoletti, A., Furlan, R., Quartieri, F., . . . for the Evaluation of Guidelines in Syncope Study, G. (2010). Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. European Heart Journal, 31(16), 2021-2026. https://doi.org/10.1093/eurheartj/ehq017
Yau, L., Mukarram, M. A., Kim, S. M., Arcot, K., Thavorn, K., Stiell, I. G., . . . Thiruganasambandamoorthy, V. (2019). Outcomes and emergency medical services resource utilization among patients with syncope arriving to the emergency department by ambulance. CJEM Canadian Journal of Emergency Medical Care, 21(4), 499-504. https://doi.org/10.1017/cem.2018.464
Zimmermann, T., du Fay de Lavallaz, J., Nestelberger, T., Gualandro, D. M., Lopez-Ayala, P., Badertscher, P., . . . Bilici, M. (2022). International Validation of the Canadian Syncope Risk Score : A Cohort Study. Annals of Internal Medicine, 175(6), 783-794. https://doi.org/10.7326/M21-2313