This report provides a strong basis for related questions, but it also highlights a gap between administrative data at this level and data at the level of the clinic and the patient. The first gap is the eventual diagnosis and outcome. For example, we know almost nothing about the diagnosis of the patients in the study, and there are no electrocardiographic data. In many other studies, abnormal electrocardiographic findings provide significant prognostic value (3). We can infer that many had heretofore undeclared cardiovascular disease because they had an increased likelihood of subsequent cardiovascular admissions, stroke, and insertion of pacemakers and defibrillators. We have no idea of the cause of their deaths nor how their courses compared with those of syncope patients with previously declared comorbidities. There is no information on their course in hospital or subsequent clinics nor on their health care consumption and the efficiency of their workup. What is missing and would be of considerable interest is information on how physicians made their decisions to investigate ((11),12) and with which tools. Several risk-stratification tools based in the emergency department have appeared over the past 10 years, but they generally would have screened out this group as they usually feature markers such as known heart disease, heart failure, anemia, dyspnea, and advancing age ((3),8). Finally, there are the limitations based on studies from single countries. How do these patients and this health care system compare with those of other countries, particularly those without anything resembling a unitary system?