Electrocardiogram and cardiac testing among patients in the emergency department with seizure versus syncope

Jennifer L. White, Judd E. Hollander, Jesse M. Pines, Peter M. Mullins, Anna Marie Chang

Research output: Contribution to journalArticle

Abstract

Objective Cardiogenic syncope can present as a seizure. The distinction between seizure disorder and cardiogenic syncope can only be made if one considers the diagnosis. Our main objective was to identify whether patients presenting with a chief complaint (reason for visit) as seizure or syncope received an electrocardiogram in the emergency department across all age groups. Methods We conducted a secondary analysis of data collected in the 2010 to 2014 National Hospital Ambulatory Medical Care Survey comparing patients presenting with a chief complaint of syncope versus seizure to determine likelihood of getting an evaluation for possible life threatening cardiovascular disease. The primary endpoint was receiving an electrocardiogram in the emergency department; secondary endpoint was receiving cardiac biomarkers. Results There was a total of 144,094 patient encounters. Of these visits, 1,553 had syncope and 1,470 had seizure (60.3% vs. 44.2% female, 19.9% vs. 29.0% non-white). After adjusting for age, sex, mode of arrival and insurance, patients with syncope were more likely to receive an electrocardiogram compared to patients with seizure (odds ratio, 10.86; 95% confidence interval [CI], 8.52 to 13.84). This was true across all age groups (0 to 18 years, 56% vs. 7.5%; 18 to 44 years, 60% vs. 27%; 45 to 64 years, 82% vs. 41%; ≥65 years, 85% vs. 68%; P<0.01 for all). Cardiac biomarkers were also obtained more frequently in adult patients with syncope patients (18 to 44 years, 17.5% vs. 10.5%; 45 to 64 years, 33.8% vs. 21.4%; ≥65 years, 47.1% vs. 32.3%; P<0.01 for all). Conclusion Patients evaluated in the emergency department for syncope received an electrocardiogram and cardiac biomarkers more frequently than those that had seizure.

Original languageEnglish (US)
Pages (from-to)106-112
Number of pages7
JournalClinical and Experimental Emergency Medicine
Volume6
Issue number2
DOIs
StatePublished - Jun 1 2019

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Syncope
Hospital Emergency Service
Electrocardiography
Seizures
Biomarkers
Age Groups
Health Care Surveys
Insurance
Epilepsy
Cardiovascular Diseases
Odds Ratio
Confidence Intervals

Keywords

  • Electrocardiography
  • Seizures
  • Syncope

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Electrocardiogram and cardiac testing among patients in the emergency department with seizure versus syncope. / White, Jennifer L.; Hollander, Judd E.; Pines, Jesse M.; Mullins, Peter M.; Chang, Anna Marie.

In: Clinical and Experimental Emergency Medicine, Vol. 6, No. 2, 01.06.2019, p. 106-112.

Research output: Contribution to journalArticle

White, Jennifer L. ; Hollander, Judd E. ; Pines, Jesse M. ; Mullins, Peter M. ; Chang, Anna Marie. / Electrocardiogram and cardiac testing among patients in the emergency department with seizure versus syncope. In: Clinical and Experimental Emergency Medicine. 2019 ; Vol. 6, No. 2. pp. 106-112.
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abstract = "Objective Cardiogenic syncope can present as a seizure. The distinction between seizure disorder and cardiogenic syncope can only be made if one considers the diagnosis. Our main objective was to identify whether patients presenting with a chief complaint (reason for visit) as seizure or syncope received an electrocardiogram in the emergency department across all age groups. Methods We conducted a secondary analysis of data collected in the 2010 to 2014 National Hospital Ambulatory Medical Care Survey comparing patients presenting with a chief complaint of syncope versus seizure to determine likelihood of getting an evaluation for possible life threatening cardiovascular disease. The primary endpoint was receiving an electrocardiogram in the emergency department; secondary endpoint was receiving cardiac biomarkers. Results There was a total of 144,094 patient encounters. Of these visits, 1,553 had syncope and 1,470 had seizure (60.3{\%} vs. 44.2{\%} female, 19.9{\%} vs. 29.0{\%} non-white). After adjusting for age, sex, mode of arrival and insurance, patients with syncope were more likely to receive an electrocardiogram compared to patients with seizure (odds ratio, 10.86; 95{\%} confidence interval [CI], 8.52 to 13.84). This was true across all age groups (0 to 18 years, 56{\%} vs. 7.5{\%}; 18 to 44 years, 60{\%} vs. 27{\%}; 45 to 64 years, 82{\%} vs. 41{\%}; ≥65 years, 85{\%} vs. 68{\%}; P<0.01 for all). Cardiac biomarkers were also obtained more frequently in adult patients with syncope patients (18 to 44 years, 17.5{\%} vs. 10.5{\%}; 45 to 64 years, 33.8{\%} vs. 21.4{\%}; ≥65 years, 47.1{\%} vs. 32.3{\%}; P<0.01 for all). Conclusion Patients evaluated in the emergency department for syncope received an electrocardiogram and cardiac biomarkers more frequently than those that had seizure.",
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AB - Objective Cardiogenic syncope can present as a seizure. The distinction between seizure disorder and cardiogenic syncope can only be made if one considers the diagnosis. Our main objective was to identify whether patients presenting with a chief complaint (reason for visit) as seizure or syncope received an electrocardiogram in the emergency department across all age groups. Methods We conducted a secondary analysis of data collected in the 2010 to 2014 National Hospital Ambulatory Medical Care Survey comparing patients presenting with a chief complaint of syncope versus seizure to determine likelihood of getting an evaluation for possible life threatening cardiovascular disease. The primary endpoint was receiving an electrocardiogram in the emergency department; secondary endpoint was receiving cardiac biomarkers. Results There was a total of 144,094 patient encounters. Of these visits, 1,553 had syncope and 1,470 had seizure (60.3% vs. 44.2% female, 19.9% vs. 29.0% non-white). After adjusting for age, sex, mode of arrival and insurance, patients with syncope were more likely to receive an electrocardiogram compared to patients with seizure (odds ratio, 10.86; 95% confidence interval [CI], 8.52 to 13.84). This was true across all age groups (0 to 18 years, 56% vs. 7.5%; 18 to 44 years, 60% vs. 27%; 45 to 64 years, 82% vs. 41%; ≥65 years, 85% vs. 68%; P<0.01 for all). Cardiac biomarkers were also obtained more frequently in adult patients with syncope patients (18 to 44 years, 17.5% vs. 10.5%; 45 to 64 years, 33.8% vs. 21.4%; ≥65 years, 47.1% vs. 32.3%; P<0.01 for all). Conclusion Patients evaluated in the emergency department for syncope received an electrocardiogram and cardiac biomarkers more frequently than those that had seizure.

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