Format

Send to

Choose Destination
Ann Emerg Med. 2019 May 9. pii: S0196-0644(19)30250-1. doi: 10.1016/j.annemergmed.2019.03.031. [Epub ahead of print]

Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis.

Author information

1
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: mprobst@gmail.com.
2
Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.
3
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
4
Department of Emergency Medicine, University of Rochester, Rochester, NY.
5
Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
6
Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA.
7
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
8
Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI.
9
Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX.
10
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
11
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
12
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
13
Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI.
14
Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH.
15
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.

Abstract

STUDY OBJECTIVE:

Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days.

METHODS:

We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days.

RESULTS:

We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%).

CONCLUSION:

In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center