In this issue of Heart, Del Rosso et al report the results of a prospective validation study of a clinical assessment tool for adults attending the emergency department with a history of transient loss of consciousness (see page 1620).1 The scoring system, which “cannot be used as a substitute for clinical judgment of the experts” is geared towards identifying those patients who have a cardiac cause and is intended to serve as an aid for junior doctors providing front-line care in busy emergency departments. The proposed screening tool has a high sensitivity and relatively high specificity.

THE RELEVANCE OF SYNCOPE

Syncope has an enormous medical, social and economic impact on the general population. In the Framingham Heart Study, the incidence of a first report of syncope was 6.2 per 1000 person-years,2 and it is estimated that about 35% of people faint at least once in their life.3 Syncope evaluation accounts for 3–5% of emergency department visits and 1–6% of hospital admissions,4 and although many of these episodes are “benign” (eg, vasovagal or situational),5 they still have significant implications for individual subjects, resulting in physical injury, unnecessary hospital admissions, loss of economic productivity, driving restrictions and impaired quality of life. …