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Table 1 Drop-down menu options for physicians charting syncope presentations. Menu options are adapted from the following recommendations in the 2007 ACEP Clinical Policy of Syncope [18]. “Cranial CT scanning need not be routinely performed unless guided by specific findings in the history or physical examination.” “Consider older age, structural heart disease, or a history of coronary artery disease as risk factors for adverse outcome.” “Admit patients with syncope and evidence of heart failure or structural heart disease.” “Admit patients with…older age and associated comorbidities, abnormal ECG, Hct <30 (if obtained), history or presence of heart failure, coronary artery disease, or structural heart disease”

From: Knowledge translation of the American College of Emergency Physicians’ clinical policy on syncope using computerized clinical decision support

EKG risk stratification Reason head CT ordered Reason admission considered
•No acute/concerning changes •Syncope led to head trauma •Older age WITH comorbidities
•Signs of ischemia •Suspected seizure •Anemia with hct <30, if obtained
•Signs of dysrhythmia (Brugada syndrome, WPW) •Focal neurologic deficit •Abnormal EKG
•Conduction abnormalities (LBBB, prolonged intervals) •Incomplete resolution of altered MS •Signs of heart failure/CAD/cardiomyopathy
  •Requested by other provider •Family history of sudden death
   •Other concerning history or physical findings