Variation in Rates of Hospital Admission for Low-risk Syncope Presenting to the Emergency Department

Authors

Anthony Mazzella
Brian Wood, Corewell Health
Jagroop Doad, Corewell Health West Resident
Michael Hendrickson
Lindsey A. Rosman
Anil K. Gehi

Document Type

Conference Proceeding

Publication Date

5-19-2024

Publication Title

Heart Rhythm

Abstract

Background

Syncope is responsible for over one million visits to emergency departments (ED) in the United States per year. However, little is known about variation in hospital admission for patients with low-risk syncope.

Objective

To quantify interhospital variation in admission patterns for patients with low-risk syncope presenting to the ED after accounting for patient and hospital level factors.

Methods

In this cross-sectional observational cohort study, we identified all ED encounters for adults with a primary diagnosis of syncope from the Nationwide Emergency Department Sample from 2006 to 2019. A low-risk cohort was identified based on ACC/AHA/HRS guidelines. Multivariable hierarchical logistic regression analyses examined the association of patient and hospital factors on admission. Reference effect measures methodology determined the relative effect of patient, measured hospital, and unmeasured hospital variation.

Results

Of 3,206,739 ED encounters, 804,398 (25.1%) met criteria for low-risk syncope of which 20,260 (2.5%) were admitted. Patient and hospital level demographic factors associated with decreased or increased odds of admission are shown (Figure). Extensive unmeasured hospital variation was observed when comparing the odds of similar patients presenting to hospitals less likely (5th percentile) or more likely (95th percentile) to admit for low-risk syncope (95% OR range 0.23 to 4.38). Unmeasured hospital variation was greater than the impact of all measured hospital factors (95% OR range 0.65 to 1.30) and patient factors (95% OR range 0.33 to 3.68).

Conclusion

Findings suggest that variation in admission rates for low-risk syncope is primarily driven by institutional norms and cultures as well as heterogeneity of physician decision-making within hospitals, both of which could be targets of interventions to modify rates of admission. Further research and clinical guidance are needed to standardize management of low-risk syncope in the ED.

Volume

21

Issue

5 Supplement

First Page

S682

Comments

Heart Rhythm 2024, May 16-19, 2024, Boston, MA

Last Page

S683

Recommended Citation

Mazzella A, Wood B, Doad J, Hendrickson M, Rosman LA, Gehi AK. Variation in rates of hospital admission for low-risk syncope presenting to the emergency department. Heart Rhythm. 2024 May 19;21(5_ Suppl): S682-S683. doi: 10.1016/j.hrthm.2024.03.1672.

DOI

10.1016/j.hrthm.2024.03.1672