It is possible that the element of elusiveness of the symptoms of near syncope is the reason for the lack of an accepted definition (1, 2). For this reason, hardly any studies exist of the symptom complex near syncope, and affected patients are only rarely included in systematic studies. We can only reiterate at this point that near syncope is a disease syndrome that—as we showed in our article—is of general practical relevance and therefore has to be approached in a structured manner. We tried to put into practice an existing definition from earlier studies in a replicable manner and thereby create a basis for further studies of this topic (1).
Professor Möckel et al as well as others have taken us up on our use of a wide range of end points in our study. This criticism is probably based on the specialty specific perspective of the symptom complex that is syncope, with specialty defined end points. In our understanding of emergency medicine we suggest to keep the wide selection of end points, since syncope/near syncope are associated with different life-threatening disorders. These very different, life-threatening causes from the whole range of acute medicine equally require adequate treatment in the same way as defined cardiac end points. One might have a splendid discourse about the acute relevance of moderate hyponatremia, which, however, is associated with increased mortality and therefore needs to be approached therapeutically (3). In conclusion, in the emergency admissions setting, the widely defined combined end point should be used, as has also been recommended by international studies. What remains undisputed is the need for objectifiable risk stratification in view of the use of algorithms. We are only just starting out in this respect, and we look forward to further results from multicenter prospective analyses on the topic.
Prof. Dr. med. Michael Christ, Yvonne Greve
Klinik für Notfall- und Internistische Intensivmedizin
Paracelsus Medizinische Privatuniversität Nürnberg
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
|1.||Greve Y, Geier F, Popp S, et al.: The prevalence and prognostic significance of near syncope and syncope—a prospective study of 395 cases in an emergency department (the SPEED Study). Dtsch Arztebl Int 2014; 111: 197–204 VOLLTEXT|
|2.||Grossman SA, Babineau M, Burke L, Kancharla A, Mottley L, Nencioni A, et al.: Do outcomes of near syncope parallel syncope? Am J Emerg Med 2012; 30: 203–6 CrossRef MEDLINE|
|3.||Hoorn EJ, Zietse R: Hyponatremia and mortality: moving beyond associations. Am J Kidney Dis 2013; 62: 139–49. |