Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis - 20/07/19
, Erica Su, BS b, Robert E. Weiss, PhD b, Annick N. Yagapen, MPH, CCRP c, Susan E. Malveau, MSBE c, David H. Adler, MD, MPH d, Aveh Bastani, MD e, Christopher W. Baugh, MD, MBA f, Jeffrey M. Caterino, MD, MPH g, Carol L. Clark, MD, MBA h, Deborah B. Diercks, MD, MPH i, Judd E. Hollander, MD j, Bret A. Nicks, MD, MHA k, Daniel K. Nishijima, MD, MAS l, Manish N. Shah, MD, MPH m, Kirk A. Stiffler, MD n, Alan B. Storrow, MD o, Scott T. Wilber, MD n, Benjamin C. Sun, MD, MPP cAbstract |
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.
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| Please see page 261 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: MAP and BCS designed the study and drafted the article. BCS obtained funding. ANY and SEM were responsible for data collection and management. ES and REW provided statistical advice on study design and analyzed the data. All authors contributed substantially to article revision and approved the final report for submission. ES, REW, ANY, SEM, and BCS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. BCS takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Research reported in this publication was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) under award R01HL111033. Dr. Probst is supported by a Career Development Award from the NHLBI (K23HL132052). Dr. Shah reports receiving research funding from Roche and Omron, Inc. Dr. Adler reports receiving research funding from Roche. Dr. Bastani reports receiving research funding from Radiometer and Portola and being a consultant for Portola. Dr. Baugh reports receiving advisory board and speaker’s fees from Roche, research funding from Janssen and Boehringer Ingelheim, and consulting and advisory board fees from Janssen. Dr. Caterino reports receiving funding from AstraZeneca. Dr. Clark reports receiving research funding from Radiometer, Ortho Clinical Trials, Janssen, Pfizer, NIH, Portola, BioCryst, GlaxoSmithKlein, Hospital Quality Foundation, and Abbott, and is also a consultant for Portola, Janssen, and Hospital Quality Foundation. Dr. Diercks is a consultant for Janssen and Roche; has received institutional research support from Novartis, Ortho Scientific, and Roche; and is on the editorial board for Academic Emergency Medicine and Circulation. Dr. Hollander reports receiving research funding from Alere, Siemens, Roche, Portola, and Trinity. Dr. Nishijima reports receiving honorarium from Pfizer. Dr. Storrow is a consultant for Siemens and Quidel and is on the data and safety monitoring board for Trevena. Dr. Sun is a consultant for Medtronic. |
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| Trial registration number: NCT01802398 |
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| The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Roche Diagnostics supplied high-sensitivity troponin T assays. The sponsoring organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article. |
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Vol 74 - N° 2
P. 260-269 - août 2019 Retour au numéro
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