Predictors of 30-Day Serious Events in Older Patients With Syncope
Presented at the American Geriatric Society annual scientific meeting, May 2009, Chicago, IL; and the Society for Academic Emergency Medicine annual meeting, May 2009, New Orleans, LA.
Received 22 May 2009; received in revised form 9 July 2009; accepted 28 July 2009. published online 22 September 2009.
Study objective
We identify predictors of 30-day serious events after syncope in older adults.
Methods
We reviewed the medical records of older adults (age ≥60 years) who presented with syncope or near syncope to one of 3 emergency departments (EDs) between 2002 and 2005. Our primary outcome was occurrence of a predefined serious event within 30 days after ED evaluation. We used multivariable logistic regression to identify predictors of 30-day serious events.
Results
Of 3,727 potentially eligible patients, 2,871 (77%) met all eligibility criteria. We excluded an additional 287 patients who received a diagnosis of a serious clinical condition while in the ED. In the final study cohort (n=2,584), we identified 173 (7%) patients who experienced a 30-day serious event. High-risk predictors included age greater than 90 years, male sex, history of an arrhythmia, triage systolic blood pressure greater than 160 mm Hg, abnormal ECG result, and abnormal troponin I level. A low-risk predictor was a complaint of near syncope rather than syncope. A risk score, generated by summing high-risk predictors and subtracting the low-risk predictor, can stratify patients into low- (event rate 2.5%; 95% confidence interval [CI] 1.4% to 3.6%), intermediate- (event rate 6.3%; 95% CI 5.1% to 7.5%), and high-risk (event rate 20%; 95% CI 15% to 25%) groups.
Conclusion
We identified predictors of 30-day serious events after syncope in adults aged 60 years and greater. A simple score was able to stratify these patients into distinct risk groups and, if externally validated, might have the potential to aid ED decisionmaking.
aDepartment of Medicine, University of California, Los Angeles, Los Angeles, CA
bDepartment of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
cDivision of Research and Evaluation, Kaiser Permanente–Southern California, Pasadena, CA
dEmergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
eSchool of Public Health, University of California, Los Angeles, Los Angeles, CA
Address for correspondence: Benjamin Sun, MD, MPP, Office 3214A, Mail Stop 111, Building 500, Wing 3E, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd, Los Angeles, CA 90073; 310-268-3002, fax 310-268-4818
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 that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Sun is supported by a UCLA National Institute of Aging K12 award (K12AG001004) and an American Geriatrics Society Dennis Jahnigen Career Development Award (20051687). Drs. Mangione and Moore received support from the Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME), funded by the National Institutes of Health/National Institute on Aging (P30 AG021684), and from the UCLA/Drew Project EXPORT, funded by the National Institutes of Health/National Center for Minority Health and Health Disparities (P20 MD000182). Dr. Sun received support from the UCLA Older Americans Independence Center, NIH/NIA Grant P30-AG028748, and the content does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.
Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedhome.com.
Reprints not available from the authors.
Supervising editor: Deborah B. Diercks, MD
Author contributions: BCS, SFD, JRH, AAM, WRM, and CMM designed the study. BCS obtained funding for this study. BCS, SFD, and GG were responsible for data collection, and BCS supervised the overall data collection process. BCS and L-JL performed the data analysis. BCS drafted the article. All authors contributed substantially to article revisions. BCS takes responsibility for the paper as a whole.
Publication date: Available online September 19, 2009.
ABSTRACT
Predictors of 30-Day Serious Events in Older Patients With Syncope