Managing Syncope Patients in the ED Observation Unit?

Emergency department (ED) observation units provide protocolized care and an assumption of discharge within 24 hours. Like chest pain, syncope is a common presentation that rarely indicates a dangerous underlying condition, and thus might be amenable to this approach. Investigators at five EDs randomized 124 patients aged ≥50 with syncope to protocolized care in an ED observation unit or routine inpatient care. Patients judged by the ED clinician to be at high risk (e.g., cardiac conditions, pulmonary embolism) or low risk (symptoms consistent with orthostatic or vasovagal syncope) were excluded.

The observation-unit protocol required 12 hours of cardiac monitoring and 6-hour serial troponin assays for all patients and echocardiograms for mo…