Serious Outcomes Among Emergency Department Patients with Presyncope: A Systematic Review

Serious Outcomes Among Emergency Department Patients with Presyncope: A Systematic Review

Authors: Hadi Mirfazaelian, Ian Stiell, Rasoul Masoomi, Khazar Garjani, Venkatesh Thiruganasambandamoorthy

Published in: Academic Emergency Medicine, 2024

Conclusions: The prevalence of short-term serious outcomes among ED patients with presyncope ranges from 4% to 27%, with arrhythmia being the most common. The findings suggest that presyncope may carry a similar risk to syncope, indicating that the same level of caution should be exercised in managing ED patients with presyncope as those with syncope.

Methods: This systematic review included ED studies that enrolled patients with presyncope and reported any short-term serious outcomes. Studies enrolling patients without presyncope (e.g., hypoglycemia, seizure, stroke) were excluded. The study was restricted to English publications and databases searched included MEDLINE, Embase, Scopus, and Web of Science, from inception to July 2023. The SIGN 50 tool was used for assessing the risk of bias.

Results: Out of 1,788 articles screened, 32 were selected for full-text assessment, and five studies (four prospective and one retrospective) involving 2,741 presyncope patients were included. Four studies were from North America and one from Europe. Despite some risk of bias, all included studies were of acceptable quality. The prevalence of overall adverse outcomes varied from 4.4% to 26.8% for all adults and 5.5% to 18.7% among older patients. Arrhythmia was the most prevalent serious outcome (17.4% in one study), followed by anemia/hemorrhage, with myocardial infarction being the third most common outcome among older patients in one study.