Key result
Previous syncope fails to predict adverse outcomes, while first episodes signal acute underlying disease.
Why the study?
Previous syncope episodes have an ambivalent prognostic role, typically indicating benign reflex syncope but sometimes prompting further investigation when frequent despite a negative ED workup.
Does a history of previous syncope episodes predict adverse outcomes in ED patients presenting with syncope?
Observational (n=378)
Does a history of previous syncope episodes predict adverse outcomes in ED patients presenting with syncope?
A first syncopal episode in the ED requires careful evaluation for underlying acute conditions, as a history of previous episodes does not correlate with adverse outcomes.
First syncope may signal acute disease warranting ED evaluation; leaves open prior episodes' role in risk models pending prospective validation.
OBJECTIVES: In the prognostic evaluation of syncopal patients, previous episodes have a somewhat ambivalent role, as they are usually associated to reflex syncope, with a benign prognosis, but according to some authors when frequent require further investigations even in case of a negative ED workup. METHODS: Retrospective observational study in a cohort of 378 ED syncopal patients to investigated the presence of previous episodes and their prognostic significance, in predicting cardiac syncope, syncope associated to underlying acute diseases and syncope severe due to consequential risk. RESULTS: We found previous syncopal episodes in over half of patients (57.4 %); mostly few (up to two episodes in total in 63.8 %), with a trends over time very rare or occasional, in a small minority complicated by major injuries. As regards the prognostic role of syncopal recurrences, we found: 1. no association between their total number in life with any outcome considered; 2. a close association between presence of acute principal diseases and absence of previous episodes; 3. a close association between severe syncope due to consequential risk and a frequent or recurrent time course of previous spells and previous episodes worsened by major injuries. CONCLUSIONS: Previous episodes, although frequent, don't correlate with adverse outcomes so don't help to identify high risk patients. Conversely, a first syncopal episode, especially in elderly patients, requires careful evaluation to rule out any underlying acute condition. Additionally, attention should be also paid to patients with previous episodes clustered in the last period or complicated by severe injuries, as they negatively impact quality of life.
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Numeroso et al. (2025) conducted an observational in Syncope (n=378). Previous syncopal episodes vs. Absence of previous syncopal episodes (first episode) was evaluated on Cardiac syncope, syncope associated to underlying acute diseases, and severe syncope due to consequential risk. Previous syncopal episodes did not correlate with adverse outcomes, whereas a first syncopal episode was closely associated with the presence of acute principal diseases.
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