A study of syncope based on age, therapeutic areas, and sub-diagnoses

Abstract: BACKGROUND: Recent recommendations on syncope have suggested the need to identify acute causes to better evaluate and treat such patients. We evaluated our experience to assess the most common causes of syncope in the acute care setting. MATERIALS AND METHODS: Medical records were reviewed of adult patients with the diagnosis of syncope in the emergency department from January 1, 2024 to December 31, 2024. All charts were reviewed anonymously, assessing presentation, diagnosis and treatment. Ages were defined by quartiles, and therapeutic area diagnoses were defined using ICD-10 coding. RESULTS: A total of 1,376 charts met the criteria for evaluation. The median age was 65 years, with 595 men/781 women. The most frequent area associated with syncope was cardiac (40%), followed by vasovagal etiologies (14%). Other etiologies included infectious (10%), gastrointestinal (GI) (6%) psychiatric, substance abuse and obstetric/gynecologic etiologies (4% each), with endocrine, trauma, and renal etiologies following (3% each). Neurologic etiologies represented 1% of the cohorts. When evaluated by age, cardiac, renal, and infectious etiologies increased with increasing age, with the oldest quartile having the highest incidence. Vasovagal, psychiatric, and substance abuse were the highest in younger quartiles, declining with increasing age. Moreover, within therapeutic areas, the sub-diagnoses changed with age quartiles. CONCLUSIONS: The diagnosis of syncope is associated with a myriad of acute etiologies spanning different medical areas, and age is a large factor with respect to incidence, therapeutic area, and sub-diagnoses within a therapeutic area to be considered in the evaluation in the acute care setting.