Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope

A Propensity-Matched Analysis

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

Research output: Contribution to journalArticle

Abstract

Study objective: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. Methods: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs)in the United States. We enrolled adults (≥60 years)who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. Results: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%)and the discharged group (2.82%)(risk difference 2.07%; 95% confidence interval –0.24% to 4.38%). Conclusion: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Syncope
Hospitalization
Hospital Emergency Service
Propensity Score
Confidence Intervals
Observational Studies
Outpatients
Observation
Prospective Studies
Incidence

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope : A Propensity-Matched Analysis. / Probst, Marc A.; Su, Erica; Weiss, Robert E.; Yagapen, Annick N.; Malveau, Susan E.; Adler, David H.; Bastani, Aveh; Baugh, Christopher W.; Caterino, Jeffrey M.; Clark, Carol L.; Diercks, Deborah; Hollander, Judd E.; Nicks, Bret A.; Nishijima, Daniel K.; Shah, Manish N.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin C.

In: Annals of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Probst, MA, Su, E, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Clark, CL, Diercks, D, Hollander, JE, Nicks, BA, Nishijima, DK, Shah, MN, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, BC 2019, 'Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis', Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2019.03.031
Probst, Marc A. ; Su, Erica ; Weiss, Robert E. ; Yagapen, Annick N. ; Malveau, Susan E. ; Adler, David H. ; Bastani, Aveh ; Baugh, Christopher W. ; Caterino, Jeffrey M. ; Clark, Carol L. ; Diercks, Deborah ; Hollander, Judd E. ; Nicks, Bret A. ; Nishijima, Daniel K. ; Shah, Manish N. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin C. / Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope : A Propensity-Matched Analysis. In: Annals of Emergency Medicine. 2019.
@article{9e137c56ee954a72ab025fed4552c9b1,
title = "Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis",
abstract = "Study objective: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. Methods: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs)in the United States. We enrolled adults (≥60 years)who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. Results: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51{\%} were women. The incidence of serious adverse events within 30 days after the index visit was 7.4{\%} for hospitalized patients and 3.19{\%} for discharged patients, representing an unadjusted difference of 4.2{\%} (95{\%} confidence interval 2.38{\%} to 6.02{\%}). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89{\%})and the discharged group (2.82{\%})(risk difference 2.07{\%}; 95{\%} confidence interval –0.24{\%} to 4.38{\%}). Conclusion: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.",
author = "Probst, {Marc A.} and Erica Su and Weiss, {Robert E.} and Yagapen, {Annick N.} and Malveau, {Susan E.} and Adler, {David H.} and Aveh Bastani and Baugh, {Christopher W.} and Caterino, {Jeffrey M.} and Clark, {Carol L.} and Deborah Diercks and Hollander, {Judd E.} and Nicks, {Bret A.} and Nishijima, {Daniel K.} and Shah, {Manish N.} and Stiffler, {Kirk A.} and Storrow, {Alan B.} and Wilber, {Scott T.} and Sun, {Benjamin C.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.annemergmed.2019.03.031",
language = "English (US)",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope

T2 - A Propensity-Matched Analysis

AU - Probst, Marc A.

AU - Su, Erica

AU - Weiss, Robert E.

AU - Yagapen, Annick N.

AU - Malveau, Susan E.

AU - Adler, David H.

AU - Bastani, Aveh

AU - Baugh, Christopher W.

AU - Caterino, Jeffrey M.

AU - Clark, Carol L.

AU - Diercks, Deborah

AU - Hollander, Judd E.

AU - Nicks, Bret A.

AU - Nishijima, Daniel K.

AU - Shah, Manish N.

AU - Stiffler, Kirk A.

AU - Storrow, Alan B.

AU - Wilber, Scott T.

AU - Sun, Benjamin C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Study objective: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. Methods: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs)in the United States. We enrolled adults (≥60 years)who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. Results: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%)and the discharged group (2.82%)(risk difference 2.07%; 95% confidence interval –0.24% to 4.38%). Conclusion: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.

AB - Study objective: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. Methods: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs)in the United States. We enrolled adults (≥60 years)who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. Results: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%)and the discharged group (2.82%)(risk difference 2.07%; 95% confidence interval –0.24% to 4.38%). Conclusion: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.

UR - http://www.scopus.com/inward/record.url?scp=85065237437&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065237437&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2019.03.031

DO - 10.1016/j.annemergmed.2019.03.031

M3 - Article

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

ER -