There are around 650,000 ED syncope presentations a year in the United Kingdom (UK). Serious underlying conditions can present with syncope and one-month serious adverse outcome is around 7% with 50% being cardiovascular. The treating ED clinician is not always able to rule out serious pathology as the patient is commonly fully recovered on arrival in the ED, despite the underlying cause being potentially life threatening should it recur again. Whilst most patients do not have a serious underlying cause and therefore do not require hospitalisation, the concern of the ED clinician about missing a serious underlying cause (especially cardiovascular ones) means that 50% of syncope patients are admitted to hospital.