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

Background: 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. Objective: 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. Methods: Three prospective cohort studies plus 2017 national guidelines for syncope management were identified, reviewed, and critically appraised. Results: This literature review found that orthostatic hypotension is common among ED patients with syncope and is often diagnosed as the cause of syncope. Conclusions: 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.