Anderson. Trends in Hospitalization, Readmission, and Diagnostic Testing of Patients Presenting to the Emergency Department With Syncope. Ann Emerg Med. 2018;72:523-532
Although this study doesn’t tell you who should be admitted it does nicely show the mortality, albeit inpatient only, and some interesting facts about admitted syncope patients.
This was a retrospective epidemiology study of syncope-related ED visits and hospitalizations using the National Emergency Department Sample from 2006 to 2014 and State Inpatient Databases and Emergency Department Databases from 2009 and 2013. Primary outcomes were annual incidence rates of syncope ED visits and subsequent hospitalizations, and rates of hospitalization, observation, 30-day revisits, and diagnostic testing comparing 2009 with 2013. From 2006 to 2014, they identified 15,154,920 ED visits for syncope. Annual rates of ED visits increased from 643 to 771 per 100,000 adults, whereas hospitalizations declined from 36.3% to 24.7%. The proportion of ED visits resulting in hospital admission decreased 12.1% between 2009 and 2013, whereas the proportion of ED visits resulting in observation care increased by 7.7%. There was no significant change in 30-day ED revisit rates for syncope (1.9 vs 1.8) and no change for all cause ED revisits (14.9% vs 15.0%) after presentation. The frequency of advanced cardiac testing increased from 13.8% to 17.0%, and neuroimaging increased from 40.6% to 44.3%. In hospital mortality was similar in both groups as well at 0.7% vs 0.9%