OBJECTIVES Syncope, defined as a transient loss of consciousness that leads to a spontaneous recovery without consequences, is very prevalent. It is known that syncope related admissions (principal diagnosis) are associated with a high cost burden for the Spanish National Health System, but little is known about the number of hospitalisations due to injuries caused by the fall (secondary diagnosis). The objective of this study was to estimate the burden and cost of syncope from the Spanish Health Care System perspective. METHODS Admissions with a primary diagnosis of syncope and admissions for injuries and pacemaker/defibrillator implantations where syncope was coded as a secondary diagnosis were analysed. The source of data was the Spanish Basic Minimum Data Set and the period 2001-2010. RESULTS The annual incidence of syncope-related admission was 4.22 cases/10,000 inhab. The annual average number of admissions was 15,703, including 77.5% syncope as a primary diagnosis. The total annual cost of syncope related admissions was €46mill, from which a 46.4% was associated to injuries where syncope was coded as a secondary diagnosis. The average cost of a patient admitted with syncope as a primary and secondary diagnosis was €2,062 (min €1,556 – max €28,772) and €5,996 (min €719 – max €26,940) respectively. The average length of stay for patients with syncope as a primary and secondary diagnosis was 5.17 and 9.33 days respectively. CONCLUSIONS Syncope has an important cost burden resulted from the high number of hospitalisations and the length of stay associated. The cost of a patient admitted with syncope as a secondary diagnosis was nearly 3 times higher than a patient with a primary diagnosis of syncope.  It is important to implement health strategies to diagnose these patients in order to assure an efficient management of the available resources.