Assessment of a structured management pathway for patients referred to the Emergency Department for syncope: results in a tertiary hospital
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AIMS: High hospitalization rates (39-58% in the literature) of patients admitted to Emergency Department (ED) for transient loss of consciousness (T-LOC) suspected for syncope are still an unresolved issue. The presence of an Observation Unit has reduced hospital admissions and the duration of hospitalization in controlled studies, and a Syncope Unit (SU) in the hospital may reduce hospitalization and increase the number of diagnoses in patients with T-LOC. We assessed the effect of a structured organization on hospitalization rate and outcome. METHODS AND RESULTS: Consecutive patients referred to the ED for a T-LOC of a suspected syncopal nature as the main diagnosis were included. The ED physician was trained to choose between: hospital admission (directly or after short observation); discharge after short (<48-h) observation; discharge on a fast track to the SU; and direct discharge without any further diagnostics. From January to June 2010, 362 patients were evaluated in the ED: 29% were admitted, 20% underwent short observation in the ED, 20% were referred to the SU, and 31% were directly discharged. Follow-up data were available on 295 patients who were discharged alive: of these, 1 (0.3%) previously hospitalized patient died within 30 days and 16 (5.4%) died within 1 year. Death rates were 12.9, 3.3, 0, and 2.5% among admitted, observation, SU, and ED-discharged patients, respectively. No death could be directly attributed to T-LOC. Re-admission within 1 year for any cause occurred in 72 (24%) patients; re-admission rates were 45.9, 19.3, 11.5, and 18.0% among admitted, observation, SU, and ED-discharged patients, respectively. CONCLUSIONS: The availability of short observation and a SU seems to reduce the hospitalization rate compared with previous reported historical reports from our and other centres. Most deaths during follow-up occurred in patients who had been hospitalized. High rates of re-admission to the ED within 1 year are still an issue.
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Older patients (>75 years of age) who present with syncope tend to have poor outcomes, both fatal and nonfatal.
“Older patients (>75 years of age) who present with syncope tend to have poor outcomes, both fatal and nonfatal (109,679,680).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [109]
The Death section (page unavailable) reports that increasing age predicted death within 12 months after an ED presentation for suspected syncope. The Follow-up section reports hospital re-admissions, but does not identify age as a predictor of re-admission; neither section establishes poor fatal and nonfatal outcomes specifically for patients over 75. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn this setting, a structured ED protocol can be effective as an alternative to inpatient admission.
“In this setting, a structured ED protocol can be effective as an alternative to inpatient admission (107–110).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [109]
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References 21 · Cited by 36
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- Authors
- Ungar, A., Tesi, F., Chisciotti, V. M., Pepe, G., Vanni, S., Grifoni, S., Balzi, D., Rafanelli, M., Marchionni, N., & Brignole, M.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Azienda Sanitaria di Firenze (IT)
- Presidio Ospedaliero (IT)
- Corresponding author
- Ungar, Andrea
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-05-14
- Volume
- 18
- Issue
- 3
- Pages
- 457-462
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2226624986
- Cited by
- 36
- References
- 21
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 11 · 2017: 7 · 2016: 1 · 2015: 2 · 2014: 1
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- 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, transient loss of consciousness, emergency department, hospitalization, syncope unit, observation unit, hospitalization rates, hospital readmission, mortality, discharge pathways
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospital Units, Humans, Italy, Length of Stay, Male, Middle Aged, Patient Admission, Patient Discharge, Prognosis, Referral and Consultation, Syncope, Time Factors, Program Evaluation, Models, Organizational, Critical Pathways, Observation, Young Adult, Tertiary Care Centers
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