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Am J Emerg Med. 2019 Mar 25. pii: S0735-6757(19)30186-X. doi: 10.1016/j.ajem.2019.03.036. [Epub ahead of print]

Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study.

Author information

1
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America; Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America. Electronic address: jennifer.white2@jefferson.edu.
2
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
3
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America.
4
Department of Biostatistics, University of California, Los Angeles, CA, United States of America.
5
Department of Emergency Medicine, University of Rochester, NY, United States of America.
6
Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America.
7
Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America.
8
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
9
Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America.
10
Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America.
11
Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America.
12
Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America.
13
Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America.
14
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.

Abstract

BACKGROUND:

Syncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope.

METHODS:

We performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs.

RESULTS:

The study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18).

CONCLUSIONS:

In a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes.

PMID:
30928476
DOI:
10.1016/j.ajem.2019.03.036

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