BACKGROUND AND IMPORTANCE: In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES: To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN: Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS: Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS: Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION: This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.

Attikon University Hospital Athens Greece

Complejo Hospitalario Universitario Regional de Málaga Malaga Spain

Department of Emergency and Acute Medicine Campus Mitte and Virchow Charité Universitätsmedizin Berlin Berlin Germany

Department of Emergency Medicine Gazi University Faculty of Medicine Ankara Turkey

Emergency Department of the Medical University of Vienna Austria

Emergency Department Regionshospitalet Randers Denmark

Emergency Medicine Department CHU Tours Tours University Tours France

Emergency Medicine Discipline 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj Napoca Cluj Napoca Romania

Emergency Medicine Research Group Edinburgh Royal Infirmary of Edinburgh

Emergency Unit University of Medicine and Pharmacy Cluj University Emergency County Hospital Cluj Napoca Romania

European Society for Emergency Medicine Antwerp Belgium

General Hospital Health Centre Zaječar Serbia

Hospital Clínic IDIBAPS University of Barcelona Barcelona Catalonia Spain

Hospital Universitario Marques de Valdecilla SCS Santander

Mater Dei Hospital Msida Malta

Royal Infirmary of Edinburgh Edinburgh UK

Santa Maria della Misericordia Hospital Perugia Italy

Semmelweis University ED Budapest Hungary

St Vincents University Healthcare Group Dublin Ireland

University Hospital Centre Mother Teresa of Tirana Tirana Albania

University Hospital Hradec Králové Czech Republic

University of Edinburgh Medical School Edinburgh UK

University of Medicine and Pharmacy Grigore T Popa Iasi Romania

Usher Institute University of Edinburgh Edinburgh UK

Vithas Xanit International Hospital Malaga Malaga Spain

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