Demographics of Syncope in a Regional Australia

Abstract Background Syncope is one of the commonest presentations to the Emergency Departments. There is limited data on the incidence of syncope in regional Australia. Syncope is classified by its aetiological causes and each cause is characterised by different clinical features and prognosis. Identifying the cause of syncope patients is essential to preventing patient morbidity and mortality. Investigating the demographics of syncope in regional Australia may lead to better outcome. Results The age-adjusted causes of syncope showed a significant rise in cardiac syncope in patients aged above 60 (P=0.03) whereas patients below 30 were more likely to suffer from reflex syncope (P=0.0001). There are considerable overlaps such as prodromal symptoms or prior positions of patients between different types of syncope. 77 from 178 Patients (43.3%) would be classified as high risk. 18 out of 24 (75%) cardiac syncope patients were classified as high-risk, whereas barely more than 35% (18 out of 51) of patients with reflex syncope were high-risk. Patients with cardiac syncope were more likely to be admitted or referred for further evaluation such as telemetry, Holter monitor and echocardiogram (P=0.0001). Cause-adjusted mortality showed that patients with orthostatic syncope had significantly worse outcome compared to other groups (P=0.04), cardiac syncope patients were not associated with increased mortality (P=0.37). Conclusions The current study showed that Syncope is a frequent diagnosis within the emergency department. The incidence of syncope of unknown cause remains very high despite extensive investigations. Clinical features such as prodromal symptoms, prior position or activities leading to syncope did not show significantly difference between causes, therefore are unreliable resources in determining the cause of syncope. Orthostatic syncope was associated with the highest mortality rate therefore we recommend paying particular attention, specialist referral and more extensive investigations in patients with orthostatic syncope.