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Key Points Question What are the characteristics of patients with active cancer presenting to US emergency departments? Findings In this multicenter cohort study of 1075 adult patients with active cancer in the Comprehensive Oncologic Emergencies Research Network (CONCERN), patients commonly presented with symptoms such as pain (62.1%) and nausea (31.3%), were frequently treated for potential infection (26.5%), and were admitted (57.2%; 25.0% for <2 days) or placed in observation (7.6%). Meaning Opportunities for improving emergency department care for patients with cancer include establishing protocols and processes for prompt and appropriate symptom control, creating improved risk stratification tools, and improving outpatient management to prevent ED visits.

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Study Hypothesis Older adults are frequently hospitalized from the emergency department (ED) after an episode of unexplained syncope. Current admission patterns are costly with little evidence of benefit. We hypothesized that an Emergency Department Observation Syncope Protocol would reduce resource use without adversely affecting patient-oriented outcomes. Methods This randomized trial at five EDs compared an ED observation syncope protocol to inpatient admission for intermediate-risk adults (≥50 years) presenting with syncope or near-syncope. Primary outcomes included inpatient admission rate and length-of-stay. Secondary outcomes included 30-day and 6-month serious outcomes after hospital discharge, index and 30-day hospital costs, 30-day quality-of-life scores, and 30-day patient satisfaction. Results Study staff randomized 124 patients. Observation resulted in a lower inpatient admission rate (15% vs. 92%, 95%CI Difference: −88%, −66%) and shorter hospital length-of-stay (29 vs. 47 hours, 95%CI Difference: −28, −8). Serious outcome rates after hospital discharge were similar for observation vs. admission at 30-days (3% vs. 0%, 95%CI Difference: −1%, 8%) and 6-months (8% vs. 10%, 95%CI Difference: −13%, 9%). Index hospital costs in the observation group were $629 (95%CI Difference: −$1376, −$56) lower than in the admission group. There were no differences in 30-day quality-of-life scores or in patient satisfaction. Conclusions An ED observation syncope protocol reduced the primary outcomes of admission rate and hospital length-of-stay. Analyses of secondary outcomes suggest reduction in index hospital costs with no difference in safety events, quality-of-life, or patient satisfaction. Our findings suggest that an ED observation syncope protocol can be replicated and safely reduce resource use.

Author Contributions Statement: BCS and MAP designed the study. BCS obtained funding for this study. ANY and SEM were responsible for data collection and management. TG and REW provided statistical advice on study design and analyzed the data. MAP and BCS drafted the manuscript. All authors contributed substantially to manuscript revisions. BCS takes responsibility for the paper as a whole. BCS, TG, REW, ANY, and SEM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final report for submission.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.