Diagnostic Yield of Hospitalization for ED Patients With Syncope and Presyncope

Diagnostic Yield of Hospitalization for ED Patients With Syncope and Presyncope
 Authors: Baugh CW, Winskill C, Suh EH, Sacco DL, DeAngelis J, Nishijima DK, Schimmel J, Storrow AB, Wood N, Weiss RE, Probst MA
 Journal: Academic Emergency Medicine, August 2026

Conclusions:

  • For adults ≥40 with syncope/presyncope and no serious ED diagnosis, hospitalization was associated with higher diagnostic yield for serious adverse outcomes and faster time to diagnosis.

  • This supports admitting select higher-risk patients, even when the ED workup does not identify a clear dangerous cause.

  • Practical takeaway: this paper pushes back against the idea that admission for unexplained syncope is always “low yield”—in appropriately selected older adults, inpatient monitoring/workup can reveal important diagnoses.

Practice Takeaways:

  • Admission may be reasonable for unexplained syncope/presyncope when risk remains meaningfully elevated despite a nondiagnostic ED evaluation.

  • Higher-risk features still matter: older age, abnormal ECG, known structural heart disease, exertional syncope, syncope while supine, palpitations, anemia/bleeding concern, persistent abnormal vitals, or concerning comorbidities.

  • The likely value of admission is monitoring and expedited diagnosis, especially for intermittent arrhythmias or evolving cardiac disease.

  • Presyncope should not be automatically treated as benign; this study included both syncope and presyncope in a population where serious outcomes were still found.

  • Important limitation: this does not mean all older syncope patients need admission. It supports selective hospitalization after ED risk stratification, shared decision-making, and consideration of reliable follow-up.

Results:

  • Population: 1,263 ED patients aged ≥40 with syncope or presyncope and no serious diagnosis identified in the ED.

  • Mean age: 64.8 ± 13.1 years.

  • 30-day serious adverse outcomes:

    • Any SAO: 74 patients (5.9%)

    • Serious cardiac outcomes: 62 patients (4.9%)

  • After propensity-score adjustment, hospitalization was associated with higher diagnostic yield:

    • OR 3.70; 95% credible interval 1.85–6.82

  • In propensity-score-matched Cox regression, hospitalization was associated with faster diagnosis of SAO:

    • HR 12.43; 95% CI 2.94–52.48

Methods:

  • Secondary analysis of a prospective, multicenter, observational study.

  • Included ED patients ≥40 years old presenting with syncope or presyncope.

  • Excluded patients with a serious diagnosis already identified in the ED.

  • Outcomes included 30-day serious adverse outcomes, cardiac and non-cardiac.

  • For admitted patients, analysis counted in-hospital SAOs; for discharged patients, counted all 30-day SAOs.

  • Used propensity-score adjustment and matching, with logistic and Cox regression analyses comparing admitted vs discharged patients.

Baugh, C.W., Winskill, C., Suh, E.H., Sacco, D.L., DeAngelis, J., Nishijima, D.K., Schimmel, J., Storrow, A.B., Wood, N., Weiss, R.E. and Probst, M.A., 2026. Diagnostic Yield of Hospitalization for Emergency Department Patients With Syncope and Presyncope. Academic Emergency Medicine, 33(8), p.e70393. 

Back to blog