The syncope core management process in the emergency department: a consensus statement of the EUSEM syncope group

Area of Science:

• Emergency Medicine
• Cardiology
• Clinical Pathway Development

Background:

• Existing 2018 European Society of Cardiology syncope guidelines offer limited process-oriented instructions for emergency department (ED) management of transient loss of consciousness (TLOC).
• Syncope patients present a diagnostic challenge in the ED due to the wide spectrum of potential underlying causes.
• Variability in syncope patient management exists across European EDs.

Purpose of the Study:

• To establish a European consensus on the general workup and care process for patients with suspected syncope in the ED.
• To provide systematic management rules for syncope patients (initially presenting as TLOC) in the ED.
• To develop a universal process pathway for structured syncope management in European EDs.

Main Methods:

• A modified Delphi process involving three rounds was conducted by the European Society for Emergency Medicine syncope group.
• Review and summarization of various European diagnostic and therapeutic standards for syncope patients.
• Development of an extended event process chain (eEPC) and a practice-based flowchart algorithm.

Main Results:

• A universally applicable syncope eEPC for EDs was successfully developed, summarizing and homogenizing syncope patient management.
• The consensus pathway provides structured management for syncope patients presenting with TLOC.
• An exemplary flowchart algorithm was created for practical application in the ED.

Conclusions:

• The developed eEPC offers a standardized approach to syncope management in European EDs.
• Key aspects include ruling out life-threatening conditions, differentiating syncope from non-syncopal TLOC, and utilizing risk stratification.
• The pathway facilitates informed decisions regarding patient admission or discharge.