7-025 Management of syncope on the medical admissions unit

Résumé fourni par la source

Introduction Syncope management in acute settings is not universally standardized according to international guidelines, with limited awareness among many acute medical and nursing staff. Additionally, there is a lack of a structured approach to risk stratification, despite its importance given the significant mortality implications of non-neurally mediated syncope. A structured algorithm is essential to ensure appropriate patient triage, minimizing unnecessary admissions for low-risk patients while reserving telemetry and monitored beds for high-risk cases. Methods Retrospective review of consecutive patients with syncope presenting to the Emergency Department and Medical Admissions Unit at the RVI from April to June 2024 was performed. Patients’ records were scrutinised for history, assessment, triage, investigations performed and subsequent management. Comparisons were then made with low-risk, intermediate-risk and high-risk classifications outlined in the ESC Syncope Guidelines 2018 with investigations, monitoring, admission patterns, and diagnoses. Results Records of 99 patients were reviewed, with a range of 23–98 years and mean of 75 years. Additional findings revealed that lying and standing blood pressure was not properly documented in 41% of patients, and family history was not assessed in 85% of cases. Both assessments are recommended by the ESC Syncope Guidelines for the evaluation of syncopal patients. Conclusion ESC 2018 Syncope guidelines were not consistently followed in terms of risk stratification. Furthermore, even among patients who were correctly stratified, appropriate inpatient monitoring was not always conducted. To address these gaps, we have developed an evidence-based algorithmic approach to acute management, which will be implemented and followed by a re-audit to assess its impact.

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