Multicenter Emergency Department Validation of the Canadian Syncope Risk Score [published online ahead of print, 2020 Mar 23]. Thiruganasambandamoorthy V, Sivilotti MLA, Le Sage N, et al. JAMA Intern Med. 2020;180(5):1-8. doi:10.1001/jamainternmed.2020.0288
Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope. Thiruganasambandamoorthy V, Rowe BH, Sivilotti MLA, McRae AD, Arcot K, Nemnom MJ, Huang L, Mukarram M, Krahn AD, Wells GA, Taljaard M. Circulation. 2019 Mar 12;139(11):1396-1406. doi: 10.1161/CIRCULATIONAHA.118.036088. PMID: 30661373
Serious underlying arrhythmia was often identified within the first 2 hours of ED arrival for CSRS low-risk patients and within 6 hours for CSRS medium- and high-risk patients. Outpatient cardiac rhythm monitoring for 15 days for selected medium-risk patients and all high-risk patients discharged from the hospital should also be considered.
Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department: The SyMoNE Multicenter Study. Solbiati M, Dipaola F, Villa P, Seghezzi S, Casagranda I, Rabajoli F, Fiorini E, Porta L, Casazza G, Voza A, Barbic F, Montano N, Furlan R, Costantino G. Acad Emerg Med. 2020 Jan;27(1):15-23. doi: 10.1111/acem.13842. Epub 2019 Dec 19. PMID: 31854141
Although the overall diagnostic accuracy of ECG monitoring is fair, its sensitivity at >12 hours' duration is substantially higher. These results suggest that prolonged (>12 hours) monitoring is a safe alternative to hospital admission in the management of non-low-risk patients with syncope in the ED.
Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient, Canadian journal of cardiology, February 2017Volume 33, Issue 2, Pages 189–198
Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope: A Multicenter Prospective Cohort Study. Thiruganasambandamoorthy V, Sivilotti MLA, Rowe BH, McRae AD, Mukarram M, Malveau S, Yagapen AN, Sun BC; North American Syncope Consortium. Ann Emerg Med. 2019 Jan 25. pii: S0196-0644(18)31535-X. doi: 10.1016/j.annemergmed.2018.12.005. [Epub ahead of print] PMID: 30691921
Conclusion: The estimated prevalence of PE in patients presenting with syncope is low. The Prandoni et al. estimates are significantly higher, suggesting a possible site effect, accrual bias, or investigation strategy. These and the prognostic impact of higher PE prevalence require understanding before changes in practice.