Do Orthostatic Vital Signs Have Utility in the Evaluation of Syncope?

Syncope is a common presentation in the emergency department (ED). The differential diagnosis is long and includes benign conditions as well as acute life threats, such as dysrhythmias or pulmonary embolism. The specific goals of this review are twofold: 1) to define the diagnostic utility of orthostatic vital signs (OVS) as a test for orthostatic syncope, and 2) to determine whether OVS help diagnose or exclude life-threatening causes of syncope in ED patients. Three prospective cohort studies plus 2017 national guidelines for syncope management were identified, reviewed, and critically appraised. This literature review found that orthostatic hypotension is common among ED patients with syncope and is often diagnosed as the cause of syncope. OVS measurements do not, in isolation, reliably diagnose or exclude orthostatic syncope, nor do they appear to have value in ruling out life-threatening causes of syncope.