Abstract Body (Do not enter title and authors here): Introduction: Syncope is a common condition often leading to testing and hospital admissions. Research assessing sex-based differences in the workup as well as disposition following emergency department (ED) syncope visits is scarce. In this study, we sought to address this gap using a national database.

Methods: From 2010 to 2019, we identified syncope patients using ICD-9 and ICD-10 codes. Using data from the IBM MarketScan Research Database, which captures de-identified individual-level health data from approximately 100 commercial payers and self-insured corporations in the United States, we assessed the incidence of testing using CPT codes in the 3 months following syncope diagnosis. Furthermore, we evaluated the percentage of syncope patients discharged from the ED. Sex-based comparisons were performed using the Chi-square test.

Results: A total of 557,416 patients (54.0% women) were included in the cohort to assess for testing disparities (these are the patients who had at least 3 months of continuous enrollment following syncope diagnosis). Compared to men, women had significantly lower testing in most domains: long-term monitoring (6.8% vs. 7.4%), echocardiogram (13.3% vs. 17.2%), cardiac stress test (4.0% vs. 7.4%), chest X-ray (17.7% vs. 25.5%), imaging for pulmonary embolism (1.5% vs. 2.0%) and carotid Doppler ultrasound (5.4% vs. 7.3%); p< 0.001 for all above comparisons, figure 1A. Tilt table testing was similar between both sexes (1.4% vs. 1.3%).

A total of 1,325,023 patients (58.1% women) were included in the ED disposition cohort. Women presenting to the ED with syncope were more likely to be discharged compared to men (78.7% vs 72.1%; p< 0.001), and this trend remained consistent throughout the study period, figure 1B.

Conclusion: Women presenting with syncope are less likely to receive testing compared to men, and more likely to be discharged from the ED. There is a need to evaluate the reasons behind these disparities and assess their impact on patients’ outcomes.