Marc A Probst1, Thomas A Gibson2, Robert E Weiss2, Annick N Yagapen3, Susan E Malveau3, David H Adler4, Aveh Bastani5, Christopher W Baugh6, Jeffrey M Caterino7, Carol L Clark8, Deborah B Diercks9, Judd E Hollander10, Bret A Nicks11, Daniel K Nishijima12, Manish N Shah13, Kirk A Stiffler14, Alan B Storrow15, Scott T Wilber14, Benjamin C Sun3. 1. Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA. mprobst@gmail.com. 2. Department of Biostatistics, University of California, Los Angeles, California, USA. 3. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, Oregon, USA. 4. Department of Emergency Medicine, University of Rochester, New York, USA. 5. Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, Michigan, USA. 6. Department of Emergency Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA. 7. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 8. Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, USA. 9. Department of Emergency Medicine, University of Texas-Southwestern, Dallas, Texas, USA. 10. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 11. Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA. 12. Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California, USA. 13. Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA. 14. Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, Ohio, USA. 15. Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Abstract
BACKGROUND: Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. OBJECTIVE: To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. DESIGN: Prospective, observational cohort study from April 2013 to September 2016. SETTING: Eleven EDs in the United States. PATIENTS: We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). MEASUREMENTS: The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. RESULTS: A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography. REGISTRATION: ClinicalTrials.gov Identifier NCT01802398.
BACKGROUND:Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. OBJECTIVE: To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. DESIGN: Prospective, observational cohort study from April 2013 to September 2016. SETTING: Eleven EDs in the United States. PATIENTS: We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). MEASUREMENTS: The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. RESULTS: A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncopepatients are at very low risk of having clinically significant findings on echocardiography. REGISTRATION: ClinicalTrials.gov Identifier NCT01802398.
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