Initial Evaluation of "Syncope and Collapse" the Need for a Risk Stratification Consensus

Patients presenting with transient loss of consciousness (TLOC) in whom clinical findings suggest a diagnosis of “syncope” account for approximately 1% of emergency department (ED) and urgent care clinic visits (1,2). On average, 30% to 40% of these patients are admitted to hospital (3,4), resulting (on the basis of data from the year 2000 evaluating “syncope and collapse” [DRG-141] as primary diagnosis) in excess of 200,000 hospital admissions annually in the U.S.; a comparable number of admissions also list “syncope and collapse” as a secondary diagnosis. The approximate hospital-stay cost of caring for these patients in the year 2000 was estimated to approach $2.5 billion (3), and it is reasonable to assume that this calculation is a substan tial underestimate of the total cost inasmuch as it did not account for either payments by private insurers or for physician fees. Additionally, the total cost has almost certainly increased during the past 10 years since the evaluation by Sun et al. (3) was completed.