Emergency department management of syncope: need for standardization and improved risk stratification
Abstract
Variations in emergency department (ED) syncope management have not been well studied. The goals of this study were to assess variations in management, and emergency physicians' risk perception and disposition decision making. We conducted a prospective study of adults with syncope in six EDs in four cities over 32 months. We collected patient characteristics, ED management, disposition, physicians' prediction probabilities at index presentation and followed patients for 30 days for serious outcomes: death, myocardial infarction (MI), arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage, or procedural interventions. We used descriptive statistics, ROC curves, and regression analyses. We enrolled 3662 patients: mean age 54.3 years, and 12.9 % were hospitalized. Follow-up data were available for 3365 patients (91.9 %) and 345 patients (10.3 %) suffered serious outcomes: 120 (3.6 %) after ED disposition including 48 patients outside the hospital. After accounting for differences in patient case mix, the rates of ED investigations and disposition were significantly different (p < 0.0001) across the four study cities; as were the rates of 30-day serious outcomes (p < 0.0001) and serious outcomes after ED disposition (p = 0.0227). There was poor agreement between physician risk perception and both observed event rates and referral patterns (p < 0.0001). Only 76.7 % (95 % CI 68.1-83.6) of patients with serious outcomes were appropriately referred. There a…
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A recent study showed wide variations in the management of syncope in emergency departments, and poor agreement between disposition decisions by physicians and significant differences in the 30-day rate of serious outcomes across the study centres.
“A recent study showed wide variations in the management of syncope in emergency departments, and poor agreement between disposition decisions by physicians and significant differences in the 30-day rate of serious outcomes across the study centres. 11”
From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [11]
The proportion of patients with syncope who are admitted to hospital, and the evaluation and investigations ordered both in the emergency department and in hospital, vary greatly among physicians, institutions and countries.
“The proportion of patients with syncope who are admitted to hospital, and the evaluation and investigations ordered both in the emergency department and in hospital vary greatly among physicians, institutions and countries. 1,10,11”
From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [11]
Because of wide variation in the disposition of patients with syncope at the study sites, including both admitted and discharged patients in the analysis avoids bias.
“Because of wide variation in the disposition of patients with syncope at the study sites, 11 we included both admitted and discharged patients in our analysis to avoid bias.”
From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [11]
Cites
Shen, W. K., Decker, W. W., Smars, P. A., Goyal, D. G., Walker, A. E., Hodge, D. O., Trusty, J. M., Brekke, K. M., Jahangir, A., Brady, P. A., et al. (2004) · Circulation · doi:10.1161/01.cir.0000149236.92822.07 · Cited by 318 · see citing works
Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes
Quinn, J., McDermott, D., Stiell, I., Kohn, M., & Wells, G. (2006) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2005.11.019 · Cited by 309 · see citing works
Self-citationShort- and Long-Term Prognosis of Syncope, Risk Factors, and Role of Hospital Admission
Costantino, G., Perego, F., Dipaola, F., Borella, M., Galli, A., Cantoni, G., Dell’Orto, S., Dassi, S., Filardo, N., Duca, P. G., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.08.059 · Cited by 246 · see citing works
Transient loss of consciousness: the value of the history for distinguishing seizure from syncope
Hoefnagels, W. A. J., Padberg, G. W., Overweg, J., Velde, E. A., & Roos, R. A. C. (1991) · Journal of Neurology · doi:10.1007/bf00319709 · Cited by 187 · see citing works
Predicting Adverse Outcomes in Syncope
Grossman, S. A., Fischer, C., Lipsitz, L. A., Mottley, L., Sands, K., Thompson, S., Zimetbaum, P., & Shapiro, N. I. (2007) · The Journal of Emergency Medicine · doi:10.1016/j.jemermed.2007.04.001 · Cited by 155 · see citing works
Failure to validate the San Francisco Syncope Rule in an independent emergency department population
Birnbaum, A., Esses, D., Bijur, P., Wollowitz, A., & Gallagher, E. J. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.12.007 · Cited by 148 · see citing works
External validation of the San Francisco Syncope Rule
Sun, B. C., Mangione, C. M., Merchant, G., Weiss, T., Shlamovitz, G. Z., Zargaraff, G., Shiraga, S., Hoffman, J. R., & Mower, W. R. (2007) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2006.11.012 · Cited by 128 · see citing works
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Thiruganasambandamoorthy, V., Kwong, K., Wells, G. A., Sivilotti, M. L. A., Mukarram, M., Rowe, B. H., Lang, E., Perry, J. J., Sheldon, R., Stiell, I. G., et al. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.151469 · Cited by 149 · see citing works
Self-citation
- Authors
- Thiruganasambandamoorthy, V., Taljaard, M., Stiell, I. G., Sivilotti, M. L. A., Murray, H., Vaidyanathan, A., Rowe, B. H., Calder, L. A., Lang, E., McRae, A., Sheldon, R., & Wells, G. A.
- Affiliations
- University of Ottawa (CA)
- Queen's University (CA)
- Ottawa Hospital (CA)
- University of Alberta (CA)
- University of Calgary (CA)
- Corresponding author
- Thiruganasambandamoorthy, Venkatesh
- ORCID
- Venue
- Internal and Emergency Medicine
- Published
- 2015-04-28
- Volume
- 10
- Issue
- 5
- Pages
- 619-627
- ISSN
- 1828-0447 (ISSN-L)
- 1970-9366
- OpenAlex
- W1983329995
- Cited by
- 39
- References
- 7
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 3 · 2022: 1 · 2021: 8 · 2020: 4 · 2019: 5 · 2018: 6 · 2017: 2 · 2016: 3
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Internal and Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- syncope, emergency department management, variation in care, risk stratification, hospital referral, standardization of care
- MeSH terms
- Clinical Decision-Making, Adolescent, Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Middle Aged, Practice Patterns, Physicians', Prognosis, Prospective Studies, ROC Curve, Syncope, Outcome Assessment, Health Care, Risk Assessment, Young Adult
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