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Syncope is a prevalent disorder, accounting for 3–5% of emergency department (ED) visits and 1–3% of hospital admissions.1 A cardiac cause of syncope is an independent predictor of sudden death, and mortality rates are higher in patients with cardiac syncope compared with those of non-cardiac or unknown origin.2 In addition, significant morbidity may result from falls or accidents resulting from syncope. Bartoletti et al. 3 have provided valuable information about the prevalence and the characteristics of secondary trauma among patients referred to the ED for a transient, self-limited loss of consciousness (TLOC). A total of 1114 patients with a true syncope and 139 individuals with a non-syncopal condition (including seizures, cerebrovascular accidents, dizziness, intoxication, hypoglycaemia, and psychogenic disorders) who presented during a period of 24 months were enrolled in this single-centre study. Among the 1253 consecutive patients with TLOC, 365 reported a trauma, which was classified as severe in 59 cases.The prevalence and the location of trauma did not differ significantly between patients with syncope and individuals with non-syncopal conditions. Among patients with true syncope, traumatic injuries were more frequent when syncope occurred at home, in the orthostatic position, and without prodromal symptoms. As expected, older age, syncope at home, and TLOC in an upright position were associated with severe trauma. Syncope at home as a predictor of trauma seems to reflect patient characteristicts that are associated with increased risk of injury, including advanced age, cognitive impairment, and reduced physical activity.4 Falls account for 90% of hip fractures, and the risk of falling increases with age as a result of impaired regulation of cerebral blood flow and polypharmacy.5 Compared with a younger woman, a 70-year-old woman is … *Corresponding author. Tel: +43 7722 804 5000, Email: johann.auer{at}khbr.at/johann.auer{at}khsim.de

Syncope and trauma. Are syncope-related traumatic injuries the key to find the specific cause of the symptom?