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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.

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Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:
Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
Department of Emergency Medicine, University of Rochester, Rochester, NY.
Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
Department of Emergency Medicine, Brigham & Women's Hospital, 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.
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI.
Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.



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.


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.


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%).


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.

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