Predictors of 30-Day Serious Events in Older Patients With Syncope

Abstract

Study objective: We identify predictors of 30-day serious events after syncope in older adults. Methods:We reviewed the medical records of older adults (age Ն60 years) who presented with syncope or near syncope to one of 3 emergency departments (EDs) between 2002 and 2005. Our primary outcome was occurrence of a predefined serious event within 30 days after ED evaluation. We used multivariable logistic regression to identify predictors of 30-day serious events.Results: Of 3,727 potentially eligible patients, 2,871 (77%) met all eligibility criteria. We excluded an additional 287 patients who received a diagnosis of a serious clinical condition while in the ED. In the final study cohort (nϭ2,584), we identified 173 (7%) patients who experienced a 30-day serious event. High-risk predictors included age greater than 90 years, male sex, history of an arrhythmia, triage systolic blood pressure greater than 160 mm Hg, abnormal ECG result, and abnormal troponin I level. A low-risk predictor was a complaint of near syncope rather than syncope. A risk score, generated by summing high-risk predictors and subtracting the low-risk predictor, can stratify patients into low-(event rate 2.5%; 95% confidence interval [CI] 1.4% to 3.6%), intermediate-(event rate 6.3%; 95% CI 5.1% to 7.5%), and high-risk (event rate 20%; 95% CI 15% to 25%) groups. Conclusion:We identified predictors of 30-day serious events after syncope in adults aged 60 years and greater. A simple score was able to stratify these patients into distinct risk groups and, if externally validated, might have the potential to aid ED decisionmaking.

Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope

“…4 Inclusion of patients with serious adverse events identified in the emergency department introduces bias in the tool (e.g., low hematocrit is identified as a risk factor if patients with obvious gastrointestinal bleeding in the emergency department were included, but it is no longer significant after exclusion of these patients). 9,13,28 In our study, we found predisposition to vasovagal syncope to be negatively associated with serious adverse events. The Evaluation of Guidelines in Syncope Study (EGSYS) score, developed to identify patients with cardiac syncope, reported a similar finding.…”

National Cost Savings From Observation Unit Management of Syncope

“…1 We then used the results of a previous retrospective analysis of this patient population to estimate the percentage of these visits that are intermediate-risk, justifying the need for further hospitalization following the initial ED evaluation, but also not clearly requiring inpatient admission. 20 Previous studies show that older patients presenting to the ED with syncope are hospitalized at high rates, approaching 90%, 21,22 so we proceeded with the basic assumption that the intermediate-risk cohort requires hospitalization.…”

Acil Servise Senkop Şikâyeti ile Başvuran Hastalarda 30 Günlük Mortalite ve Morbidite Değerlendirilmesi

“…There was no anemia in the patients who died within 30 days and we found no effect of anemia on the development of severe events in our study. (10). The fact that a severe event developed in only two of our patients and that these two patients were hospitalized shows that we evaluated the risk criteria in these patients correctly.…”