Is Presyncope as Serious as Syncope?

Syncope has three components:

1. Loss of consciousness
2. Loss of postural tone and
3. Return to baseline

Patients with syncope comprise about 1% of all Emergency Department(ED) presentations. The cause may be benign, however there are a proportion of patients that have serious causes ie., cardiac causes, which may be associated with significant morbidity and mortality. There is also the burden of potential trauma that may be associated with the collapse. Further, we may find that in the elderly patient, the presentation of syncope may be associated with increased admission rates.

Is presyncope the same as syncope in terms of risks? Although we consider presyncope to be part of the same disease spectrum as causes syncope, we know that less patients with pre-syncope are admitted. We really have little guidance in the literature on the pre-syncope patient.

Mirfazaelian et al (1) performed a synthesis of the literature  and looked at short-term serious outcomes among ED patients with pre-syncope and compared them to those with syncope. They hypothesized that "syncope and presyncope are on the same spectrum of disease and carry the same risk of serious outcomes".

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