Brief ReportLimited yield of hospitalization for the evaluation of syncope in patients presenting to an urban tertiary medical center

•We examine the inpatient evaluation of syncope after non-diagnstic ED evaluation.•We retrospectively reviewed consecutive presentations to the 2nd busiest ED in U.S.•The etiology for syncope remained undiagnosed in 74% after an ED evaluation.•Diagnosis was made in 15% with acute intervention in 1% of these inpatients.•Admission for an unclear etiology of syncope is of low-yield.

Syncope is a frequent presenting complaint in the emergency department and is associated with significant medical costs. We examined the utility of inpatient evaluation of syncope for patients in whom a diagnosis was not established in the emergency department. We retrospectively reviewed consecutive patients presenting with syncope to an urban tertiary care medical center. A diagnosis was not established after initial evaluation in the emergency department in 171 of 230 patients admitted. Inhospital evaluation led to a diagnosis in 26 patients. Acute intervention was required in 2 patients. Our observations suggest that an inpatient evaluation of syncope for patients in whom a diagnosis is not made on initial evaluation is of low yield, and outpatient follow-up may be safe.