A Narrative Review of Syncope Decision Rules: A Case for Point-of-Care Cardiac Ultrasound for Cardiac Syncope

Syncope is a common complaint among Emergency Department patients. There are innumerable causes for syncope, and it poses a diagnostic challenge for Emergency Medicine (EM) physicians. Currently, several clinical decision rules (CDRs) for risk stratification of patients presenting with syncope depend on the circumstances surrounding the syncopal event, past medical history, vital signs, and results of basic diagnostic studies. However, the basis of these clinical decision tools is unreliable, such as the past medical history or nonspecific findings for various disease processes that can cause syncope. Given risk factors from unreliable sources, this raises the question: are we misclassifying our syncope patients? We posit in this narrative review that there is a role for a bedside diagnostic test, performed by the Emergency Medicine clinician, to assist with accurate risk stratification of syncope-causing pathologies: point-of-care cardiac ultrasound (POCCUS).