[Diagnostics of Patients with Syncope of Unknown Origin: Indications for Hospital Admission and for In- and Out-hospital Services?]

The diagnostic challenge of patients with syncope is to assess the underlying cause leading to the symptom syncope. In addition, the patient's risk for an increased mortality and for recurrent syncope has to be evaluated. Initial evaluation identifies most of these patients. Depending on the local medical health services this can be performed in an emergency department, an in- and out-hospital service or at a general practitioner. Major criteria for hospital admission are risk stratification especially for patients with a suspected rhythm-related reason for syncope and treatments to prevent syncopal recurrences. Hospital admission is not necessary for patients with a single attack or infrequent episodes who show no evidence of a cardiac cause for the syncope or of a structural heart disease. Patients who have no findings indicating the presence of life-threatening rhythm disorders can be further evaluated in a hospital or an out-clinic setting depending on the predetermined requirements of local professional bodies.