Cristian Toarta1, Muhammad Mukarram2, Kirtana Arcot2, Soo-Min Kim2, Sarah Gaudet2, Marco L A Sivilotti3, Brian H Rowe4, Venkatesh Thiruganasambandamoorthy2,5. 1. Division of Emergency Medicine, University of Toronto, Toronto, Ontario. 2. Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario. 3. Department of Emergency Medicine and the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario. 4. Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta. 5. Department of Emergency Medicine and the Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with presyncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit, and physicians' confidence in assigning the etiology were collected. Serious outcomes at 30 days included death, arrhythmia, myocardial infarction, structural heart disease, pulmonary embolism, and hemorrhage. RESULTS: A total of 5,010 patients (mean ± SD age = 53.4 ± 23.0 years; 54.8% females) were enrolled; 3.5% suffered serious outcomes-deaths (0.3%), arrhythmias (1.8%), nonarrhythmic cardiac (0.5%), and noncardiac (0.9%) including pulmonary embolism (0.2%). The cause of syncope was presumed as vasovagal among 53.3% and cardiac in 5.4% of patients. The proportion of patients with ED investigations (p < 0.001) and short-term serious outcomes (p < 0.01) increased in each diagnostic category in the following order: presumed vasovagal, orthostatic hypotension, other/unknown cause, and cardiac. No deaths occurred in patients with presumed vasovagal syncope. A higher proportion of all serious outcomes occurred among patients suspected of cardiac syncope in the ED (p < 0.01). Confidence was highest among physicians for a presumed vasovagal syncope diagnosis and lowest when the cause was other/unknown. CONCLUSION: Short-term serious outcomes strongly correlated with the etiology assigned in the ED visit. The importance of the physician's clinical judgment should be further studied to determine if it should become incorporated in risk-stratification tools for prognostication and safe management of ED syncope patients.
OBJECTIVE: Relatively little is known about outcomes after disposition among syncopepatients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncopepatients at six EDs and excluded patients with presyncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit, and physicians' confidence in assigning the etiology were collected. Serious outcomes at 30 days included death, arrhythmia, myocardial infarction, structural heart disease, pulmonary embolism, and hemorrhage. RESULTS: A total of 5,010 patients (mean ± SD age = 53.4 ± 23.0 years; 54.8% females) were enrolled; 3.5% suffered serious outcomes-deaths (0.3%), arrhythmias (1.8%), nonarrhythmic cardiac (0.5%), and noncardiac (0.9%) including pulmonary embolism (0.2%). The cause of syncope was presumed as vasovagal among 53.3% and cardiac in 5.4% of patients. The proportion of patients with ED investigations (p < 0.001) and short-term serious outcomes (p < 0.01) increased in each diagnostic category in the following order: presumed vasovagal, orthostatic hypotension, other/unknown cause, and cardiac. No deaths occurred in patients with presumed vasovagal syncope. A higher proportion of all serious outcomes occurred among patients suspected of cardiac syncope in the ED (p < 0.01). Confidence was highest among physicians for a presumed vasovagal syncope diagnosis and lowest when the cause was other/unknown. CONCLUSION: Short-term serious outcomes strongly correlated with the etiology assigned in the ED visit. The importance of the physician's clinical judgment should be further studied to determine if it should become incorporated in risk-stratification tools for prognostication and safe management of ED syncopepatients.
Authors: Venkatesh Thiruganasambandamoorthy; Marco L A Sivilotti; Natalie Le Sage; Justin W Yan; Paul Huang; Mona Hegdekar; Eric Mercier; Muhammad Mukarram; Marie-Joe Nemnom; Andrew D McRae; Brian H Rowe; Ian G Stiell; George A Wells; Andrew D Krahn; Monica Taljaard Journal: JAMA Intern Med Date: 2020-05-01 Impact factor: 21.873
Authors: Veera K van Wijnen; Dik Ten Hove; Reinold O B Gans; Wybe Nieuwland; Arie M van Roon; Jan C Ter Maaten; Mark P M Harms Journal: Emerg Med J Date: 2018-01-24 Impact factor: 2.740
Authors: Franca Barbic; Franca Dipaola; Giovanni Casazza; Marta Borella; Maura Minonzio; Monica Solbiati; Satish R Raj; Robert Sheldon; James Quinn; Giorgio Costantino; Raffaello Furlan Journal: J Clin Med Date: 2019-01-29 Impact factor: 4.241