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Ann Emerg Med. 2018 Dec 7. pii: S0196-0644(18)31420-3. doi: 10.1016/j.annemergmed.2018.10.032. [Epub ahead of print]

Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope.

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Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI. Electronic address:
Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA.
Department of Emergency Medicine, University of Rochester, Rochester, NY.
Brigham and Women's Hospital, Harvard University, Boston, MA.
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI.
Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX.
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA.
Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.



Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients.


From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables.


A total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope.


Near-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.

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