Clinical Profile, Aetiological Spectrum and Short-Term Outcome of Adult Patients Presenting with Syncope to the Emergency Department: A Prospective Observational Study

Background: Syncope accounts for a considerable proportion of emergency department (ED) attendances and encompasses aetiologies ranging from entirely benign reflex faints to arrhythmias with an immediate threat to life. Data describing the clinical profile, the incremental yield of routinely ordered investigations and the short-term outcome of ED syncope in Indian practice remain limited.Methods: A prospective observational study was conducted by the Department of General Medicine in the emergency department of a tertiary care teaching hospital between June 2025 and June 2026. One hundred consecutive adults aged 18 years and above presenting with syncope were enrolled. Age, circumstances of the episode, prodromal symptoms, cardiac history, twelve-lead electrocardiogram (ECG), random blood glucose, haemoglobin, serum electrolytes and imaging findings were recorded on a structured proforma. The final aetiological diagnosis was adjudicated by two independent physicians. Disposition and 30-day serious adverse events (SAE) were recorded by structured telephonic and record-based follow-up. Chi-square, independent samples t test and multivariable logistic regression were applied, with p < 0.05 taken as significant.Results: The mean age was 48.6 ± 19.4 years and 56 (56.0%) were male. Reflex syncope was the commonest aetiology (36.0%), followed by cardiac (22.0%), orthostatic (18.0%), metabolic or other identified causes (13.0%) and unexplained syncope (11.0%). The ECG was abnormal in 39.0%, anaemia was present in 34.0%, hyponatraemia in 21.0% and hypoglycaemia in 7.0%. History, examination and ECG alone established the diagnosis in 58.0%, whereas carotid Doppler was diagnostic in none. Forty-two per cent were admitted; 30-day SAE occurred in 17.0% and 30-day mortality was 5.0%. An abnormal ECG (odds ratio [OR] 5.86, 95% confidence interval [CI] 1.72 to 19.94, p = 0.005), known cardiac disease (OR 4.27, p = 0.015), age above 60 years (OR 3.42, p = 0.035) and absence of prodrome (OR 3.11, p = 0.046) independently predicted SAE.Conclusion: Reflex syncope predominated, yet approximately one in five episodes was cardiac and accounted for the majority of short-term adverse events. Bedside evaluation supported by an ECG carried the highest diagnostic yield, while advanced imaging contributed little.Background: Syncope accounts for a considerable proportion of emergency department (ED) attendances and encompasses aetiologies ranging from entirely benign reflex faints to arrhythmias with an immediate threat to life. Data describing the clinical profile, the incremental yield of routinely ordered investigations and the short-term outcome of ED syncope in Indian practice remain limited.Methods: A prospective observational study was conducted by the Department of General Medicine in the emergency department of a tertiary care teaching hospital between June 2025 and June 2026. One hundred consecutive adults aged 18 years and above presenting with syncope were enrolled. Age, circumstances of the episode, prodromal symptoms, cardiac history, twelve-lead electrocardiogram (ECG), random blood glucose, haemoglobin, serum electrolytes and imaging findings were recorded on a structured proforma. The final aetiological diagnosis was adjudicated by two independent physicians. Disposition and 30-day serious adverse events (SAE) were recorded by structured telephonic and record-based follow-up. Chi-square, independent samples t test and multivariable logistic regression were applied, with p < 0.05 taken as significant.Results: The mean age was 48.6 ± 19.4 years and 56 (56.0%) were male. Reflex syncope was the commonest aetiology (36.0%), followed by cardiac (22.0%), orthostatic (18.0%), metabolic or other identified causes (13.0%) and unexplained syncope (11.0%). The ECG was abnormal in 39.0%, anaemia was present in 34.0%, hyponatraemia in 21.0% and hypoglycaemia in 7.0%. History, examination and ECG alone established the diagnosis in 58.0%, whereas carotid Doppler was diagnostic in none. Forty-two per cent were admitted; 30-day SAE occurred in 17.0% and 30-day mortality was 5.0%. An abnormal ECG (odds ratio [OR] 5.86, 95% confidence interval [CI] 1.72 to 19.94, p = 0.005), known cardiac disease (OR 4.27, p = 0.015), age above 60 years (OR 3.42, p = 0.035) and absence of prodrome (OR 3.11, p = 0.046) independently predicted SAE.Conclusion: Reflex syncope predominated, yet approximately one in five episodes was cardiac and accounted for the majority of short-term adverse events. Bedside evaluation supported by an ECG carried the highest diagnostic yield, while advanced imaging contributed little.