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

Authors

Aveh Bastani, Beaumont Health
Erica Su
David H Adler
Christopher Baugh
Jeffrey M Caterino
Carol L Clark, Beaumont Health
Deborah B Diercks
Judd E Hollander
Susan E Malveau
Bret A Nicks
Daniel K Nishijima
Manish N Shah
Kirk A Stiffler
Alan B Storrow
Scott T Wilber
Annick N Yagapen
Robert E Weiss
Benjamin C Sun

Document Type

Article

Publication Date

3-2019

Publication Title

Annals of emergency medicine

Abstract

STUDY OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

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

Volume

73

Issue

3

First Page

274

Last Page

280

Recommended Citation

Bastani A, Su E, Adler DH, Baugh C, Caterino JM, Clark CL, Diercks DB, Hollander JE, Malveau SE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Yagapen AN, Weiss RE, Sun BC. Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope. Ann Emerg Med. 2019 Mar;73(3):274-280. doi: 10.1016/j.annemergmed.2018.10.032. Epub 2018 Dec 7. PMID: 30529112; PMCID: PMC6387841.

DOI

10.1016/j.annemergmed.2018.10.032

ISSN

1097-6760

PubMed ID

30529112