Predictors of 30-Day Serious Events in Older Patients With Syncope

Benjamin C. Sun, Stephen F. Derose, Li Jung Liang, Gelareh Z. Gabayan, Jerome R. Hoffman, Alison A. Moore, William R. Mower, Carol M. Mangione

Research output: Contribution to journalArticle

74 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)769-778.e5
JournalAnnals of emergency medicine
Volume54
Issue number6
DOIs
StatePublished - Dec 2009

ASJC Scopus subject areas

  • Emergency Medicine

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    Sun, B. C., Derose, S. F., Liang, L. J., Gabayan, G. Z., Hoffman, J. R., Moore, A. A., Mower, W. R., & Mangione, C. M. (2009). Predictors of 30-Day Serious Events in Older Patients With Syncope. Annals of emergency medicine, 54(6), 769-778.e5. https://doi.org/10.1016/j.annemergmed.2009.07.027