Vasovagal syncope in emergency room patients: analysis of a metropolitan area registry

The aim of this study was to assess the epidemiology of syncope in unselected patients referred to an emergency room and eventually admitted to the clinical wards to perform a complete work-up, and to analyze the costs of hospitalization. The clinical charts of all patients referred for all causes to the emergency rooms of three hospitals in the Florence area during the year 2000 and of all patients admitted from the emergency rooms to the clinical wards with a diagnosis of lone-related (vasovagal) or disease-related syncope were revised. A total of 1,290 (3.36%) cases of syncope out of 38,330 presentations were registered; among these, 702 cases (1.83% of all presentations, 54% of all syncopes) were directly discharged, and 443 cases (1.14% of all presentations, 34% of all syncopes) were hospitalized. The remaining 149 cases (12% of all syncopes) refused admission. Following admission, 500 patients were discharged with the diagnosis of syncope: 115 lone-related (23%) and 385 disease-related syncopes (77%). A cost-benefit analysis of the hospitalized patients showed that admitting patients with lone syncope leads to an economical loss to the hospital.