Table 1 Criteria to determine the treating physician’s diagnosis
Treating physician’s conclusion | Criteria to evaluate concordance of the management plan with the suggested condition | |||
|---|---|---|---|---|
Admission | Follow-up | Investigations following ED visit | Treatment | |
Reflex syncope (including vasovagal syncope, carotid sinus syndrome and situational syncope) | No admission except for underlying cause (e.g. gastroenteritis) or trauma due to syncope | No referral to outpatient clinic, except for syncope unit | No investigations except for tilt test (optional) | Optional: Education in counter pressure manoeuvres Treatment with drugs that may prevent reflex syncope (e.g. midodrine) |
Orthostatic hypotension (including initial, classic and delayed orthostatic hypotension) | No admission except for underlying cause (e.g. dehydration, bleeding) | Optional: Referral to GP or outpatient clinic for analysis of underlying cause | Optional: Tilt table testing, active standing test, autonomic function test, work-up to identify underlying neurological cause (e.g. polyneuropathy) | Optional: Treatment of underlying cause (e.g. rehydration) Deprescribing of blood pressure-lowering drugs Prescription of blood pressure-increasing drugs Education in counter-pressure manoeuvres |
Cardiac syncope Cardiopulmonary and great vessels | Admission to cardiology department* except when treatment did not necessitate admission Admission if needed | Follow-up cardiology department to confirm diagnosis or evaluate treatment Follow-up pulmonologist, vascular surgeon | Optional: Monitoring heart rhythm (in-hospital, Holter ECG) Echocardiography Exercise testing Implantation of cardiac monitoring devices Imaging aorta/pulmonary veins | Optional: Implantation of pacemaker/defibrillator Surgical intervention for structural causes Prescription of anti-arrhythmical drugs Optional: Anti-thrombotic therapy Surgical intervention |
Epileptic seizure | Optional: Admission to neurology department | Referral to neurology outpatient clinic except for provoked seizures | Optional: MRI, CT brain or EEG | Optional: Prescription of anti-seizure medication |
Psychogenic TLOC | No admission except for injuries due to TLOC necessitating admission | Variable (no follow-up, referral to GP, consultation psychiatrist or psychologist) | None | Education or treatment plan as defined by psychiatrist, psychologist or GP |