Older Age Predicts Short‐Term, Serious Events After Syncope

Abstract

OBJECTIVES: To assess the relationship between age and 14-day serious events after an emergency department (ED) visit for syncope. DESIGN: One-year prospective cohort study. SETTING: Single academic ED. PARTICIPANTS: Adult patients with an ED complaint of syncope or near-syncope. MEASUREMENTS: Treating physicians prospectively recorded the presence or absence of potential risk factors for serious clinical events. Patients were contacted by telephone at 14 days for a structured interview. A three-physician panel reviewed ED charts, hospital records, and telephone interview forms to identify predefined events. The primary outcome included any 14-day predefined event. A secondary outcome included any 14-day predefined event that was first diagnosed after the initial ED visit. Age was analyzed in 20-year intervals. Multivariate logistic regression controlled for baseline demographic, comorbidity, and electrocardiogram data. RESULTS: Of 592 eligible patients, 477 (81%) provided informed consent. Follow-up was successfully obtained for 463 (97%) patients. The age range was 18 to 96, and 47% of patients were aged 60 and older. There were 80 (17%) patients who had a 14-day event, including 18 (4%) with a delayed diagnosis. Compared with patients aged 18 to 39, the adjusted odds ratio (OR) of a serious outcome was 2.7 (95% confidence interval (CI) 5 0.9-8.4) for patient aged 40 to 59, 3.8 (95% CI 5 1.3-12) for patients aged 60 to 79, and 3.8 (95% CI 5 1.2-12) for patients aged 80 and older. CONCLUSION: Age of 60 and older is strongly associated with short-term serious events after an ED visit for syncope. J Am Geriatr Soc 55: 907-912, 2007.

National Cost Savings From Observation Unit Management of Syncope

“…For example, we made our estimate for the percentage of patients ≥50 years at intermediate risk based on an analysis of patients ≥60 years of age. 22,36 In addition, the case definition of syncope we used in the NHAMCS contribution to the model may include ED visits where syncope was a secondary complaint. We feel that syncope is a cardinal complaint that often supersedes most associated symptoms in guiding ED management.…”

Current issues with prediction rules for syncope

“…2 Cardiac and other serious outcomes (adjusted for comorbidity) are also much more common among older patients with syncope (adjusted odds ratio 3.8, 95% confidence interval 1.2-12, for patients over 60 years compared with patients 18-39). 6 This increased risk among older patients is particularly important given the main finding reported by Saccilotto and colleagues, 4 namely that the San Francisco Syncope Rule (Box 1) is the most adequately validated across various populations, 8 a finding echoed in a recent, similar meta-analysis. 9 As the authors point out, al though the San Francisco Syncope Rule can aid decision-making at triage in emergency departments, it should be used only in tandem with a de tailed clinical assessment, particularly in older individuals.…”

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

“…Age has been shown to be an important predictor of SAEs. 2,19,[25][26][27] Shortness of breath has been found to be an important variable in both our study and the San Francisco Syncope Rule (SFSR) study, and in our study, it was a marker of underlying life-threatening conditions such as pulmonary embolism or massive pleural effusion. We found that patients with systolic BP , 80 mm Hg during the ED stay typically had ongoing gastrointestinal bleeding or sepsis.…”