Timothy R Holden1,2, Manish N Shah3, Tommy A Gibson4, Robert E Weiss4, Annick N Yagapen5, Susan E Malveau5, David H Adler6, Aveh Bastani7, Christopher W Baugh8, Jeffrey M Caterino9, Carol L Clark10, Deborah B Diercks11, Judd E Hollander12, Bret A Nicks13, Daniel K Nishijima14, Kirk A Stiffler15, Alan B Storrow16, Scott T Wilber15, Benjamin C Sun5. 1. Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. Department of Neurology, Washington University School of Medicine, St. Louis, MO. 3. Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. 4. Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA. 5. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR. 6. Department of Emergency Medicine, University of Rochester, Rochester, NY. 7. Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI. 8. Department of Emergency Medicine, Brigham& Women's Hospital, Boston, MA. 9. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. 10. Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI. 11. Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX. 12. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA. 13. Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC. 14. Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA. 15. Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH. 16. Department of Emergency Medicine, Vanderbilt University, Nashville, TN.
Abstract
OBJECTIVES: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
OBJECTIVES:Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS:Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
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Authors: Dawn Stacey; France Légaré; Nananda F Col; Carol L Bennett; Michael J Barry; Karen B Eden; Margaret Holmes-Rovner; Hilary Llewellyn-Thomas; Anne Lyddiatt; Richard Thomson; Lyndal Trevena; Julie H C Wu Journal: Cochrane Database Syst Rev Date: 2014-01-28
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