With syncope patients, emergency physicians are often confronted with the difficult decision of whether the patient should be admitted for inpatient evaluation and
management. Syncope patients are frequently admitted following an initial non-diagnostic evaluation because of concerns of underlying life-threatening conditions (for example, dysrhythmias, pulmonary embolism or acute coronary syndrome) or belief that inpatient evaluation will reveal the cause [12]. So the question of who should be hospitalized for syncope remains. As noted previously, the diagnostic yield of extensive work-up is relatively poor. The focus in syncope evaluation, therefore, has shifted from attempting to make a specific diagnosis to risk stratification. Through careful risk stratification, it is hoped that health care resources will be more efficiently allocated to those patients most at risk of serious outcome
and, hence, more likely to benefit from inpatient care. In a recent update of their 2001 clinical policy on syncope, the American College of Emergency Physicians emphasized the use of history, physical examination and standard