Outcomes of Patients With Syncope and Suspected Dementia

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

doi:10.1111/acem.13414

Outcomes of Patients With Syncope and Suspected Dementia

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

Research output: Contribution to journal › Article

1 Scopus citations

Abstract

Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.

Original language	English (US)
Pages (from-to)	880-890
Number of pages	11
Journal	Academic Emergency Medicine
Volume	25
Issue number	8
DOIs	https://doi.org/10.1111/acem.13414
State	Published - Aug 1 2018

ASJC Scopus subject areas

Emergency Medicine

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10.1111/acem.13414

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Holden, T. R., Shah, M. N., Gibson, T. A., Weiss, R. E., Yagapen, A. N., Malveau, S. E., Adler, D. H., Bastani, A., Baugh, C. W., Caterino, J. M., Clark, C. L., Diercks, D. B., Hollander, J. E., Nicks, B. A., Nishijima, D. K., Stiffler, K. A., Storrow, A. B., Wilber, S. T., & Sun, B. C. (2018). Outcomes of Patients With Syncope and Suspected Dementia. Academic Emergency Medicine, 25(8), 880-890. https://doi.org/10.1111/acem.13414

Outcomes of Patients With Syncope and Suspected Dementia. / Holden, Timothy R.; Shah, Manish N.; Gibson, Tommy A.; 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 B.; Hollander, Judd E.; Nicks, Bret A.; Nishijima, Daniel K.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin C.

In: Academic Emergency Medicine, Vol. 25, No. 8, 01.08.2018, p. 880-890.

Research output: Contribution to journal › Article

Holden, TR, Shah, MN, Gibson, TA, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Clark, CL, Diercks, DB, Hollander, JE, Nicks, BA, Nishijima, DK, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, BC 2018, 'Outcomes of Patients With Syncope and Suspected Dementia', Academic Emergency Medicine, vol. 25, no. 8, pp. 880-890. https://doi.org/10.1111/acem.13414

Holden, Timothy R. ; Shah, Manish N. ; Gibson, Tommy A. ; 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 B. ; Hollander, Judd E. ; Nicks, Bret A. ; Nishijima, Daniel K. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin C. / Outcomes of Patients With Syncope and Suspected Dementia. In: Academic Emergency Medicine. 2018 ; Vol. 25, No. 8. pp. 880-890.

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abstract = "Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.",

author = "Holden, {Timothy R.} and Shah, {Manish N.} and Gibson, {Tommy A.} 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 Diercks, {Deborah B.} and Hollander, {Judd E.} and Nicks, {Bret A.} and Nishijima, {Daniel K.} and Stiffler, {Kirk A.} and Storrow, {Alan B.} and Wilber, {Scott T.} and Sun, {Benjamin C.}",

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AU - Holden, Timothy R.

AU - Shah, Manish N.

AU - Gibson, Tommy A.

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 B.

AU - Hollander, Judd E.

AU - Nicks, Bret A.

AU - Nishijima, Daniel K.

AU - Stiffler, Kirk A.

AU - Storrow, Alan B.

AU - Wilber, Scott T.

AU - Sun, Benjamin C.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.

AB - Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.

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