Reasons for Hospitalization Among Emergency Department Patients With Syncope

Cook, O.; Mukarram, Muhammad; Rahman, Omair M; Kim, Soo-Min; Arcot, K.; Thavorn, Kednapa; Taljaard, Monica; Sivilotti, Marco L.A.; Rowe, Brian H.; Thiruganasambandamoorthy, Venkatesh

doi:10.1111/acem.13053

Cited by 12 publications

(6 citation statements)

References 24 publications

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“…Admission rates are quite variable from one provider, hospital, or region to another. 56 Admission rates in the US are approximately 32%, 53 while in Canada they are closer to 13%, 54 potentially due to differences in financial incentives, risk tolerance among clinicians, and availability of follow-up.…”

Section: Shared Decision-making For Moderate-risk Syncopementioning

confidence: 99%

Shared Decision-Making as the Future of Emergency Cardiology

Probst

Noseworthy

Brito

et al. 2018

Canadian Journal of Cardiology

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Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, on the basis of broad stakeholder input and previous conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient's values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism toward mutualism and improve the quality and experience of care for our patients.

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Section: Shared Decision-making For Moderate-risk Syncopementioning

confidence: 99%

Shared Decision-Making as the Future of Emergency Cardiology

Probst

Noseworthy

Brito

et al. 2018

Canadian Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…9,[12][13][14][15] Associated hospital admission rates vary from 7.4 to 83%. 1,8,10,11,[16][17][18][19][20][21][22] Standard practice includes a detailed history, performing a physical examination, standard 12-lead electrocardiography (ECG) and orthostatic blood pressure measurement. The utility of other investigations, including cardiac biomarkers, is controversial, and evidence for routine laboratory investigations is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Review article: Utility of troponin after syncope: A systematic review and meta‐analysis

Stark

Smit

Mitra

2018

Emerg Medicine Australasia

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The role of serum troponin testing in patients presenting to the ED after syncope is unclear. The aim of this systematic review was to examine the practice and utility of troponin testing among patients presenting to the ED after syncope. We conducted a search of MEDLINE, Embase, Cochrane Library, Web of Science and Scopus databases from 1990 to February 2017 using keyword and subject headings for syncope and troponin testing. Design and results of the included studies are extracted. Studies were assessed for heterogeneity and the pooled proportion of measured troponin and positive troponin result described. There were nine studies included for analysis. Significant statistical heterogeneity among studies was observed (P < 0.001). Using the random effects model, the pooled proportion of patients presenting to the ED after syncope who had troponin measured was 0.64 (95% CI 0.46-0.82). Among patients who had been troponin tested, the pooled proportion who had a positive result was 0.19 (95% CI 0.13-0.26). Variability among reported outcomes prevented further meta-analysis. Troponin testing was commonly performed for the assessment of patients with syncope with a substantial proportion returning positive results. The correlation between raised troponin and patient outcomes was not adequately reported. It is possible that an elevated troponin may indicate serious illness, rather than myocardial damage alone.

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“…The non-cardiac serious conditions are identified by thorough ED evaluation. It is the concern for occult arrhythmias that leads to hospitalisation for extensive investigations and monitoring 9. Over half of these hospitalisations are for suspected underlying arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

“…Over half of these hospitalisations are for suspected underlying arrhythmias. A recently published study reported that of those patients admitted for suspected underlying arrhythmias, over 70% of patients are discharged from hospital with no cause of syncope ever found 9. To save resources and improve patient safety, ambulatory outpatient cardiac monitoring is a proposed alternative to inpatient cardiac monitoring 9…”

Section: Introductionmentioning

confidence: 99%