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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/22\\\/17\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/22\\\/17\u0022}],\u0022ac\u0022:{\u0022spmdc;15\\\/22\\\/17\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;15\\\/22\\\/17\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003ENewer syncope protocols can improve diagnostic accuracy and risk stratification in patients presenting with syncope, leading to more appropriate treatment and reduced recurrence rates and mortality. Adherence to syncope protocols also reduces hospital admissions, inappropriate testing, and costs of diagnosis and treatment.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac syncope\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecarotid sinus massage\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecost-effectiveness\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediagnosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eelectrocardiography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eepilepsy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einsertable loop recorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epacemaker\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epsychogenic pseudosyncope\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprotocol\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esudden cardiac death\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esyncope\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etilt testing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003ECauses of transient loss of consciousness include trauma, syncope, seizures, intoxications, and metabolic disturbances. False transient loss of consciousness can occur due to psychogenic causes, pseudosyncope or pseudoseizure, \u201cdrop attacks,\u201d or cataplexy. True syncope can be due to neurally mediated reflex, orthostatic hypotension, cardiac arrhythmia, structural cardiopulmonary conditions, or unexplained causes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Signature Group developed an algorithm for rapid prediction of syncope onset by analyzing heart rate and blood pressure in 1155 patients with previous syncope [Virag N et al. \u003Cem\u003EHeart Rhythm\u003C\/em\u003E. 2007]. In this study, electroencephalogram video studies showed that heart rate parameters changed in different ways during episodes of syncope, epilepsy, and psychogenic pseudosyncope. The objective of the study was to find a quicker, less expensive way to diagnose syncope. To accomplish this, the researchers recorded electrocardiograms (ECGs) of patients during electroencephalogram video monitoring with the hypothesis that if the type of syncope could be identified using ambulatory ECG, the same principles could be applied to medium-term external or long-term implantable loop recorders (ILRs). Dr Richard Sutton, DSc, MBBS, Imperial College, London, United Kingdom, presented results. Among 45 patients, syncope was diagnosed as epilepsy (n\u2005=\u200517), psychogenic pseudosyncope (n\u2005=\u20058), or vasovagal syncope (n\u2005=\u200520) on the basis of a measure called marginality, a new approach to imaging in syncope diagnosis methods. The study results are summarized in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E, showing that marginality was low (\u0026lt;\u20054%) for tachycardia and reflex syncope but higher (\u0026gt;\u200510%) for focal epilepsy and nonepileptic attack disorder.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16743\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16743\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16743\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EDetails of Syncope Diagnoses Made by Electrocardiogram Marginality\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EDavid G. Benditt, MD, University of Minnesota, Minneapolis, Minnesota, USA, discussed assessing risk in patients presenting with syncope, and he indicated that patients with syncope may be at increased risk of mortality, including sudden cardiac death. Other risks include serious injury and loss of independence in elderly patients. There is no universal consensus on how to assess risk, but several studies are ongoing. Studies of major syncope risk stratification systems are summarized in \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16744\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16744\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16744\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EMajor Syncope Risk Stratification Systems\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EThe EGSYS study had the most robust data and employed a point score that is useful in the clinic, according to Dr Benditt. The EGSYS 2 follow-up data demonstrated an approximately 20% syncope recurrence rate at 2 years, regardless of the underlying cause [Ungar A et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2010]. Predictors of mortality included age (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001), trauma (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.018), heart disease or abnormal ECG (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001), male sex (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.030), and hypertension (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.002). An international meta-analysis including 43\u2005315 patients from 11 studies identified high-risk markers of adverse outcomes, including palpitations preceding syncope, heart disease, and syncope during effort [D\u2019Ascenzo F et al. \u003Cem\u003EInt J Cardiol\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe risks associated with syncope might be reduced with cardiac pacing in appropriate cases. Michele Brignole, MD, Ospedali del Tigullio, Lavagna, Italy, studied the benefits of cardiac pacing for patients with reflex syncope. The SUP2 study [Brignole M et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2015] evaluated 253 patients with severe unpredictable recurrent reflex syncope with carotid sinus massage (CSM), tilt testing (TT) if CSM was negative, and ILR if TT was negative. Patients with an asystolic response to 1 of the tests received a dual-chamber pacemaker (n\u2005=\u2005120). The recurrence rate among these patients was 9% at 1 year and 15% at 2 years, compared with 22% at 1 year and 37% at 2 years among patients with an ILR and no pacemaker (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe prevalence of carotid sinus syndrome was 2 to 5 times higher than in the general syncope population. Syncope was more likely to recur in patients with mixed forms of carotid sinus syndrome or positive mixed or vasodepressor TT. A positive TT might indicate hypotensive susceptibility, which can cause syncope recurrence regardless of the etiology and mechanism of syncope [Solari D et al. \u003Cem\u003EEuropace\u003C\/em\u003E. 2014; Sutton R, Brignole M. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThe algorithm used to identify patients for pacemaker implantation in the SUP2 study was revised on the basis of evidence from this and other studies (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/17\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Decision Tree: Pacing for Neurally Mediated SyncopeCI-CSS, cardioinhibitory carotid sinus syndrome; CSM, carotid sinus massage; DDD PM, dual-chamber pacemaker; ILR, implantable loop recorder; VASIS 2B, Vasovagal Syncope International Study 2B.Reproduced with permission from M Brignole, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1061858049\u0022 data-figure-caption=\u0022Decision Tree: Pacing for Neurally Mediated SyncopeCI-CSS, cardioinhibitory carotid sinus syndrome; CSM, carotid sinus massage; DDD PM, dual-chamber pacemaker; ILR, implantable loop recorder; VASIS 2B, Vasovagal Syncope International Study 2B.Reproduced with permission from M Brignole, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/17\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/17\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/17\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16742\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EDecision Tree: Pacing for Neurally Mediated Syncope\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003ECI-CSS, cardioinhibitory carotid sinus syndrome; CSM, carotid sinus massage; DDD PM, dual-chamber pacemaker; ILR, implantable loop recorder; VASIS 2B, Vasovagal Syncope International Study 2B.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EReproduced with permission from M Brignole, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EStandardization of syncope management through the introduction of syncope protocols such as this decision tree can help reduce the number of admissions, tests performed, and rate of unexplained syncope. Mohamed H. Hamdan, MD, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA, discussed how syncope protocols and clinics can improve the cost-effectiveness of syncope management.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EThe cost of syncope management is determined by hospital admissions, test utilization, and the rates of unexplained syncope and misdiagnosis. According to the European Society of Cardiology guidelines, high-risk criteria requiring prompt hospitalization or intensive evaluation are as follows: severe structural heart disease, clinical or ECG features suggesting arrhythmic syncope, and important comorbidities [Moya A et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2009]. A comparison of standardized admission criteria (Faint-Algorithm) with clinical practice found that in a single center, 58% of admissions and 6% of discharges were inappropriate [Daccarett M et al. \u003Cem\u003EEuropace\u003C\/em\u003E. 2011]. Other data demonstrated high rates of inappropriate testing among patients presenting with syncope [Edvardsson N et al. \u003Cem\u003EEuropace\u003C\/em\u003E. 2011; Mendu ML et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E. 2009; Pires LA et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E. 2001]. Studies have demonstrated rates of unexplained syncope of 52% [Brignole M et al. \u003Cem\u003EPacing Clin Electrophysiol\u003C\/em\u003E. 2011] and misdiagnoses of 12.9% [Josephson CB et al. \u003Cem\u003ECan J Neurol Sci\u003C\/em\u003E. 2007] and 39% [MacCormick JM et al. \u003Cem\u003EAnn Emerg Med\u003C\/em\u003E. 2009].\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003ESeveral studies have shown that establishing syncope protocols and units can improve diagnosis, reduce hospitalizations, and lower costs (\u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16745\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16745\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16745\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EStudies Comparing Syncope Protocols and Unit Care vs Conventional Diagnosis and Care\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-22\u0022\u003EThe evidence shows that differential diagnosis between epilepsy and syncope may be difficult, especially in retrospect. Cardiovascular evaluation including CSM, TT, and ILR may identify an alternative diagnosis in many patients with apparent epilepsy.\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003EAppropriate use of syncope protocols and syncope units can increase the rate of appropriate diagnoses and decrease admission rates, hospital stays, and unnecessary testing. The University of Wisconsin established a Faint and Fall Clinic that provides better care while being profitable. Despite the decrease in admissions and tests per diagnosis, hospitals could have increased margins due to improved quality of care and associated increase in market share.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/22\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl422\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl422\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzl422\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}