Annals of Emergency Medicine
Volume 54, Issue 6 , Pages 769-778.e5 , December 2009

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.

  • Benjamin C. Sun, MD, MPP

      Affiliations

    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
    • Corresponding Author InformationAddress 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
    • ,
  • Stephen F. Derose, MD, MS

      Affiliations

    • Division of Research and Evaluation, Kaiser Permanente–Southern California, Pasadena, CA
    • ,
  • Li-Jung Liang, PhD

      Affiliations

    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • ,
  • Gelareh Z. Gabayan, MD

      Affiliations

    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
    • ,
  • Jerome R. Hoffman, MD, MA

      Affiliations

    • Emergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
    • ,
  • Alison A. Moore, MD, MPH

      Affiliations

    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • ,
  • William R. Mower, MD, PhD

      Affiliations

    • Emergency Medicine Center, University of California, Los Angeles, Los Angeles, CA
    • ,
  • Carol M. Mangione, MD, MSPH

      Affiliations

    • Department of Medicine, University of California, Los Angeles, Los Angeles, CA
    • School of Public Health, University of California, Los Angeles, Los Angeles, CA

Received 22 May 2009 ,Revised 9 July 2009 ,Accepted 28 July 2009.

References 

  1. Sun BC, Emond JA, Camargo CA. Characteristics and admission patterns of patients presenting with syncope to US emergency departments, 1992-2000. Acad Emerg Med. 2004;11:1029–1034
  2. Sun BC, Emond JA, Camargo CA. Direct medical costs of syncope-related hospitalizations in the United States. Am J Cardiol. 2005;95:668–671
  3. Kapoor WN, Karpf M, Wieand S, et al. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983;309:197–204
  4. Lipsitz LA, Pluchino FC, Wei JY, et al. Syncope in institutionalized elderly: the impact of multiple pathological conditions and situational stress. J Chronic Dis. 1986;39:619–630
  5. Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med. 1985;55:45–54
  6. Chen LY, Shen WK, Mahoney DW, Jacobsen SJ, Rodeheffer RJ. Prevalence of syncope in a population aged more than 45 years. Am J Med. 2006;119:e1081–e1088
  7. Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med. 2002;347:878–885
  8. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med. 1997;29:459–466
  9. Colivicchi F, Ammirati F, Melina D, et al. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J. 2003;24:811–819
  10. Kapoor W, Snustad D, Peterson J, et al. Syncope in the elderly. Am J Med. 1986;80:419–428
  11. Linzer M, Yang EH, Estes NA, et al. Diagnosing syncope (Part 2: unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians). Ann Intern Med. 1997;127:76–86
  12. Huff JS, Decker WW, Quinn JV, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49:431–444
  13. Disertori M, Brignole M, Menozzi C, et al. Management of patients with syncope referred urgently to general hospitals. Europace. 2003;5:283–291
  14. Roos NP, Wennberg JE, McPherson K. Using diagnosis-related groups for studying variations in hospital admissions. Health Care Financ Rev. 1988;9:53–62
  15. Linzer M, Yang EH, Estes NA, et al. Diagnosing syncope (Part 1: value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians). Ann Intern Med. 1997;126:989–996
  16. Getchell WS, Larsen GC, Morris CD, et al. Epidemiology of syncope in hospitalized patients. J Gen Intern Med. 1999;14:677–687
  17. Sarasin FP, Hanusa BH, Perneger T, et al. A risk score to predict arrhythmias in patients with unexplained syncope. Acad Emerg Med. 2003;10:1312–1317
  18. Quinn J, McDermott D, Stiell I, et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006;47:448–454
  19. Costantino G, Perego F, Dipaola F, et al. Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study. J Am Coll Cardiol. 2008;51:276–283
  20. Del Rosso A, Ungar A, Maggi R, et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score. Heart. 2008;94:1620–1626
  21. Reed MJ, Newby DE, Coull AJ, et al. The Risk Stratification of Syncope in the Emergency Department (ROSE) pilot study: a comparison of existing syncope guidelines. Emerg Med J. 2007;24:270–275
  22. Birnbaum A, Esses D, Bijur P, et al. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52:151–159
  23. Sun BC, Mangione CM, Merchant G, et al. External validation of the San Francisco Syncope Rule. Ann Emerg Med. 2007;49:420–427e421-424
  24. Sarasin FP, Louis-Simonet M, Carballo D, et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med. 2001;111:177–184
  25. Sun BC, Hoffman JR, Mangione CM, et al. Older age predicts short-term, serious events after syncope. J Am Geriatr Soc. 2007;55:907–912
  26. Gregoratos G, Abrams J, Epstein AE, et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation. 2002;106:2145–2161
  27. Quinn J, McDermott D, Kramer N, et al. Death after emergency department visits for syncope: how common and can it be predicted?. Ann Emerg Med. 2008;51:585–590
  28. Quinn JV, Stiell IG, McDermott DA, et al. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med. 2004;43:224–232
  29. Krol RB, Morady F, Flaker GC, et al. Electrophysiologic testing in patients with unexplained syncope: clinical and noninvasive predictors of outcome. J Am Coll Cardiol. 1987;10:358–363
  30. Denes P, Uretz E, Ezri MD, et al. Clinical predictors of electrophysiologic findings in patients with syncope of unknown origin. Arch Intern Med. 1988;148:1922–1928
  31. Georgeson S, Linzer M, Griffith JL, et al. Acute cardiac ischemia in patients with syncope: importance of the initial electrocardiogram. J Gen Intern Med. 1992;7:379–386
  32. Grossman SA, Van Epp S, Arnold R, et al. The value of cardiac enzymes in elderly patients presenting to the emergency department with syncope. J Gerontol A Biol Sci Med Sci. 2003;58:1055–1058
  33. Brignole M, Alboni P, Benditt D, et al. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J. 2001;22:1256–1306
  34. Freed LA, Eagle KA, Mahjoub ZA, et al. Gender differences in presentation, management, and cardiac event-free survival in patients with syncope. Am J Cardiol. 1997;80:1183–1187
  35. Link MS, Lauer EP, Homoud MK, et al. Low yield of rule-out myocardial infarction protocol in patients presenting with syncope. Am J Cardiol. 2001;88:706–707
  36. Oh JH, Hanusa BH, Kapoor WN. Do symptoms predict cardiac arrhythmias and mortality in patients with syncope?. Arch Intern Med. 1999;159:375–380
  37. Del Rosso A, Alboni P, Brignole M, et al. Relation of clinical presentation of syncope to the age of patients. Am J Cardiol. 2005;96:1431–1435
  38. Middlekauff HR, Stevenson WG, Stevenson LW, et al. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol. 1993;21:110–116

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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 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.

PII: S0196-0644(09)01387-0

doi: 10.1016/j.annemergmed.2009.07.027

Annals of Emergency Medicine
Volume 54, Issue 6 , Pages 769-778.e5 , December 2009

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