University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Hospital Medicine


Nancy Reid



The purpose of this article is to determine the best syncope risk stratification score currently available as well as review appropriate syncope diagnosis and management. A PubMed literature search was conducted with the following search terms: syncope, guidelines, and risk. Eight pertinent articles were retrieved and serve as the basis for this clinical review. Despite multiple risk stratification scores being developed, there is no current consensus on the most efficacious system as none has proven to be consistently valid. A provider’s clinical judgement has been touted as supreme to any currently developed score. Instead of risk scores, providers should utilize the most current guidelines released by the European Society of Cardiology in 2018 and the American College of Cardiology in 2017 regarding the most appropriate work-up of syncope. In adults presenting with syncope to the ED, what methods can be utilized to appropriately risk stratify patients requiring admission to reduce healthcare costs while maintaining patient safety? The current risk stratification scores have not been externally validated, so thorough history, clinical judgement, and use of the most current, updated guidelines regarding syncope can help reduce costs spent on unnecessary admissions that are frequently low yield as the cause of syncope remains unknown. Further research is needed to firmly establish an efficacious risk stratification scoring system through prospective research.

Keywords: Syncope, risk, guidelines

Learning Objectives:

  • Identify and differentiate the three main types of syncope.
  • Understand the role of risk stratification scores in the evaluation of syncope.
  • Understand appropriate and inappropriate diagnostic testing for patients presenting with syncope.


Available when accessing via a campus IP address or logged in with a University of Lynchburg email address.

Off-campus users can also use 'Off-campus Download' button above for access.