Difficult to Categorize
The authors’ conclusion, that near syncope and syncope barely differ from one another, is difficult to categorize for the purposes of clinical practice because a clear definition for near syncope is lacking. In this setting, it is of little help that “two experienced emergency physicians” had a similar judgment of the already selected group of patients. The crucial issue is whether the patient group under study can prospectively be identified in other hospitals and if, therefore, the results are generalizable.
Furthermore, the combined end point consists of 20 components of very different degrees of severity, which furthermore include interventions that possibly result from the diagnostic evaluation of the index hospital stay and therefore are not “prognostic” in the actual sense. Furthermore the criteria according to which patients were admitted as inpatients remain unclear, and the same is true for how the index events were classified, and whether the events occurred in different frequencies in mainly inpatients or in patients receiving outpatient follow-up care.
For this reason the conclusion should focus on one sentence from the discussion, according to which the presented results showed that patient collectives in emergency departments have different medical problems than patient collectives in specialty-specific outpatient clinics, and that therefore inpatient investigation is generously indicated in emergency patients after syncope and near-syncope. Future studies should tackle a precise definition of near-syncope and means of risk-stratification, in view of the use of algorithms to evaluate these symptoms.
Prof. Dr. med. Martin Möckel
Dr. med. Julia Searle, MPH
Campus Virchow-Klinikum und Mittte
|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|