Risk stratification and prognosis of vasovagal syncope in the emergency department

Abstract

ED assessment of possible syncope patients follows a three-step approach. Syncope should be confirmed via a detailed history. Underlying causes should be identified and treated accordingly. Finally, stratification according to their risk of serious future adverse outcome should take place using clinical judgment, a risk score, or a clinical decision rule. Uncomplicated vasovagal syncope is suggested when there are no features that suggest an alternative diagnosis and no features suggestive of a cardiac cause. Most problems in the ED related to diagnosing vasovagal syncope are caused by patients with atypical vasovagal syncope (i.e., patients without any trigger or prodrome), and patients with symptoms suggestive of vasovagal syncope but with other concerning comorbidities. Nontypical vasovagal syncope can be defined as a TLoC not preceded by an evident trigger, positive tilt test, and absence of any competing diagnosis. Posture, provoking factors, and prodromal symptoms are most predictive of vasovagal syncope. Two vasovagal prediction tools exist which may help diagnosis.