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Moore AB, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Frequency of Abnormal and Critical Laboratory Results in Older Patients Presenting to the Emergency Department With Syncope. Acad Emerg Med 2020; 27:161-164. [PMID: 31837233 DOI: 10.1111/acem.13906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/02/2019] [Accepted: 12/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew B. Moore
- From the Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath & Science University Portland OR
| | - Erica Su
- Department of Biostatistics University of California Los Angeles CA
| | - Robert E. Weiss
- Department of Biostatistics University of California Los Angeles CA
| | - Annick N. Yagapen
- From the Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath & Science University Portland OR
| | - Susan E. Malveau
- From the Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath & Science University Portland OR
| | - David H. Adler
- Department of Emergency Medicine University of Rochester Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital–Troy Troy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Carol L. Clark
- Department of Emergency Medicine William Beaumont Hospital–Royal Oak Royal Oak MI
| | - Deborah B. Diercks
- Department of Emergency Medicine University of Texas‐Southwestern Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA
| | - Bret A. Nicks
- Department of Emergency Medicine Wake Forest School of Medicine Winston Salem NC
| | | | - Manish N. Shah
- Department of Emergency Medicine University of Wisconsin–Madison Madison WI
| | - Kirk A. Stiffler
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Alan B. Storrow
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Benjamin C. Sun
- and the Department of Emergency Medicine University of Pennsylvania Philadelphia PA
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2
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Probst MA, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis. Ann Emerg Med 2019; 74:260-269. [PMID: 31080027 DOI: 10.1016/j.annemergmed.2019.03.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 10/26/2022]
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.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Kirk A Stiffler
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Scott T Wilber
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
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3
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Clark CL, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope? Acad Emerg Med 2019; 26:528-538. [PMID: 30721554 DOI: 10.1111/acem.13709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. METHODS A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. RESULTS The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. CONCLUSIONS hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
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Affiliation(s)
- Carol L. Clark
- Department of Emergency Medicine William Beaumont Hospital‐Royal Oak Royal Oak MI
| | - Thomas A. Gibson
- Department of Biostatistics University of California Los Angeles, Fielding School of Public Health Los Angeles CA
| | - Robert E. Weiss
- Department of Biostatistics University of California Los Angeles, Fielding School of Public Health Los Angeles CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath, & Science University Portland OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath, & Science University Portland OR
| | - David H. Adler
- Department of Emergency Medicine University of Rochester Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital–TroyTroy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Deborah B. Diercks
- Department of Emergency Medicine University of Texas–Southwestern Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA
| | - Bret A. Nicks
- Department of Emergency Medicine Wake Forest School of Medicine Winston Salem NC
| | | | - Manish N. Shah
- Department of Emergency Medicine University of Wisconsin–Madison Madison WI
| | - Kirk A. Stiffler
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Alan B. Storrow
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath, & Science University Portland OR
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White JL, Chang AM, Hollander JE, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department. Am J Emerg Med 2019; 37:685-689. [DOI: 10.1016/j.ajem.2018.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
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White JL, Hollander JE, Chang AM, Nishijima DK, Lin AL, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study. Am J Emerg Med 2019; 37:2215-2223. [PMID: 30928476 DOI: 10.1016/j.ajem.2019.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Syncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope. METHODS We performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs. RESULTS The study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18). CONCLUSIONS In a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes.
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Affiliation(s)
- Jennifer L White
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America; Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America.
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Daniel K Nishijima
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Amber L Lin
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Erica Su
- Department of Biostatistics, University of California, Los Angeles, CA, United States of America
| | - Robert E Weiss
- Department of Biostatistics, University of California, Los Angeles, CA, United States of America
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY, United States of America
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kirk A Stiffler
- Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Scott T Wilber
- Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
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Bastani A, Su E, Adler DH, Baugh C, Caterino JM, Clark CL, Diercks DB, Hollander JE, Malveau SE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Yagapen AN, Weiss RE, Sun BC. Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope. Ann Emerg Med 2018; 73:274-280. [PMID: 30529112 DOI: 10.1016/j.annemergmed.2018.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients. METHODS From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables. RESULTS A total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope. CONCLUSION Near-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.
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Affiliation(s)
- Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
| | - Erica Su
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY
| | | | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Manish N Shah
- Department of Emergency Medicine, University of Rochester, Rochester, NY
| | - Kirk A Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Scott T Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Robert E Weiss
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
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7
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Probst MA, 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, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis. J Hosp Med 2018; 13:823-828. [PMID: 30255862 PMCID: PMC6343846 DOI: 10.12788/jhm.3082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. OBJECTIVE To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. DESIGN Prospective, observational cohort study from April 2013 to September 2016. SETTING Eleven EDs in the United States. PATIENTS We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). MEASUREMENTS The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. RESULTS A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). CONCLUSIONS If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography. REGISTRATION ClinicalTrials.gov Identifier NCT01802398.
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Affiliation(s)
- Marc A. Probst
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Tommy A. Gibson
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Robert E. Weiss
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, USA
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, USA
| | | | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, USA
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carol L. Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, USA
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, USA, USA
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Bret A. Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, N, USA
| | - Daniel K. Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kirk A. Stiffler
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA
| | - Scott T. Wilber
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, USA
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8
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Chang AM, Hollander JE, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes. Am J Emerg Med 2018; 37:869-872. [PMID: 30361153 DOI: 10.1016/j.ajem.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/04/2018] [Indexed: 12/22/2022] Open
Abstract
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. METHODS This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. RESULTS The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90-1.31; p = 0.387). CONCLUSION In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.
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Affiliation(s)
- Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Erica Su
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Robert E Weiss
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY, United States of America
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Jeffrey M Caterino
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kirk A Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH, United States of America
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, United States of America
| | - Scott T Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH, United States of America
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
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9
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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. Outcomes of Patients With Syncope and Suspected Dementia. Acad Emerg Med 2018; 25:880-890. [PMID: 29575587 PMCID: PMC6156993 DOI: 10.1111/acem.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Timothy R. Holden
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI,Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tommy A. Gibson
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - David H. Adler
- Department of Emergency Medicine, University of Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L. Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A. Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel K. Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Kirk A. Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN
| | - Scott T. Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
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10
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Nishijima DK, Lin AL, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope. Ann Emerg Med 2017; 71:452-461.e3. [PMID: 29275946 DOI: 10.1016/j.annemergmed.2017.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/14/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Cardiac arrhythmia is a life-threatening condition in older adults who present to the emergency department (ED) with syncope. Previous work suggests the initial ED ECG can predict arrhythmia risk; however, specific ECG predictors have been variably specified. Our objective is to identify specific ECG abnormalities predictive of 30-day serious cardiac arrhythmias in older adults presenting to the ED with syncope. METHODS We conducted a prospective, observational study at 11 EDs in adults aged 60 years or older who presented with syncope or near syncope. We excluded patients with a serious cardiac arrhythmia diagnosed during the ED evaluation from the primary analysis. The outcome was occurrence of 30-day serous cardiac arrhythmia. The exposure variables were predefined ECG abnormalities. Independent predictors were identified through multivariate logistic regression. The sensitivities and specificities of any predefined ECG abnormality and any ECG abnormality identified on adjusted analysis to predict 30-day serious cardiac arrhythmia were also calculated. RESULTS After exclusion of 197 patients (5.5%; 95% confidence interval [CI] 4.7% to 6.2%) with serious cardiac arrhythmias in the ED, the study cohort included 3,416 patients. Of these, 104 patients (3.0%; 95% CI 2.5% to 3.7%) had a serious cardiac arrhythmia within 30 days from the index ED visit (median time to diagnosis 2 days [interquartile range 1 to 5 days]). The presence of nonsinus rhythm, multiple premature ventricular conductions, short PR interval, first-degree atrioventricular block, complete left bundle branch block, and Q wave/T wave/ST-segment abnormalities consistent with acute or chronic ischemia on the initial ED ECG increased the risk for a 30-day serious cardiac arrhythmia. This combination of ECG abnormalities had a similar sensitivity in predicting 30-day serious cardiac arrhythmia compared with any ECG abnormality (76.9% [95% CI 67.6% to 84.6%] versus 77.9% [95% CI 68.7% to 85.4%]) and was more specific (55.1% [95% CI 53.4% to 56.8%] versus 46.6% [95% CI 44.9% to 48.3%]). CONCLUSION In older ED adults with syncope, approximately 3% receive a diagnosis of a serious cardiac arrhythmia not recognized on initial ED evaluation. The presence of specific abnormalities on the initial ED ECG increased the risk for 30-day serious cardiac arrhythmias.
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Affiliation(s)
- Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
| | - Amber L Lin
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - Robert E Weiss
- Department of Biostatistics, University of California, Los Angeles, CA
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Kirk A Stiffler
- Department of Emergency Medicine, Summa Health System, Akron, OH
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Scott T Wilber
- Department of Emergency Medicine, Summa Health System, Akron, OH
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
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11
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Nicks BA, Shah MN, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Malveau SE, Nishijima DK, Stiffler KA, Storrow AB, Wilber ST, Yagapen AN, Sun BC. Minimizing Attrition for Multisite Emergency Care Research. Acad Emerg Med 2017; 24:458-466. [PMID: 27859997 DOI: 10.1111/acem.13135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/01/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022]
Abstract
Loss to follow-up of enrolled patients (a.k.a. attrition) is a major threat to study validity and power. Minimizing attrition can be challenging even under ideal research conditions, including the presence of adequate funding, experienced study personnel, and a refined research infrastructure. Emergency care research is shifting toward enrollment through multisite networks, but there have been limited descriptions of approaches to minimize attrition for these multicenter emergency care studies. This concept paper describes a stepwise approach to minimize attrition, using a case example of a multisite emergency department prospective cohort of over 3,000 patients that has achieved a 30-day direct phone follow-up attrition rate of <3%. The seven areas of approach to minimize attrition in this study focused on patient selection, baseline contact data collection, patient incentives, patient tracking, central phone banks, local enrollment site assistance, and continuous performance monitoring. Appropriate study design, including consideration of these methods to reduce attrition, will be time well spent and may improve study validity.
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Affiliation(s)
- Bret A. Nicks
- Department of Emergency Medicine; Wake Forest School of Medicine; Winston-Salem NC
| | - Manish N. Shah
- Department of Emergency Medicine; University of Wisconsin-Madison; Madison WI
| | - David H. Adler
- Department of Emergency Medicine; University of Rochester; Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine; William Beaumont Hospital-Troy; Troy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | - Carol L. Clark
- Department of Emergency Medicine; William Beaumont Hospital-Royal Oak; Royal Oak MI
| | - Deborah B. Diercks
- Department of Emergency Medicine; University of Texas-Southwestern; Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine; Thomas Jefferson University Hospital; Philadelphia PA
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine; Oregon Heath & Science University; Portland OR
| | - Daniel K. Nishijima
- Department of Emergency Medicine; UC Davis School of Medicine; Sacramento CA
| | | | - Alan B. Storrow
- Department of Emergency Medicine; Vanderbilt University Medical Center; Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine; Summa Health System; Akron OH
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine; Oregon Heath & Science University; Portland OR
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine; Oregon Heath & Science University; Portland OR
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12
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Nishijima DK, Laurie AL, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Reliability of Clinical Assessments in Older Adults With Syncope or Near Syncope. Acad Emerg Med 2016; 23:1014-21. [PMID: 27027730 DOI: 10.1111/acem.12977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/20/2016] [Accepted: 03/27/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Clinical prediction models for risk stratification of older adults with syncope or near syncope may improve resource utilization and management. Predictors considered for inclusion into such models must be reliable. Our primary objective was to evaluate the inter-rater agreement of historical, physical examination, and electrocardiogram (ECG) findings in older adults undergoing emergency department (ED) evaluation for syncope or near syncope. Our secondary objective was to assess the level of agreement between clinicians on the patient's overall risk for death or serious cardiac outcomes. METHODS We conducted a cross-sectional study at 11 EDs in adults 60 years of age or older who presented with unexplained syncope or near syncope. We excluded patients with a presumptive cause of syncope (e.g., seizure) or if they were unable or unwilling to follow-up. Evaluations of the patient's past medical history and current medication use were completed by treating provider and trained research associate pairs. Evaluations of the patient's physical examination and ECG interpretation were completed by attending/resident, attending/advanced practice provider, or attending/attending pairs. All evaluations were blinded to the responses from the other rater. We calculated the percent agreement and kappa statistic for binary variables. Inter-rater agreement was considered acceptable if the kappa statistic was 0.6 or higher. RESULTS We obtained paired observations from 255 patients; mean (±SD) age was 73 (±9) years, 137 (54%) were male, and 204 (80%) were admitted to the hospital. Acceptable agreement was achieved in 18 of the 21 (86%) past medical history and current medication findings, none of the 10 physical examination variables, and three of the 13 (23%) ECG interpretation variables. There was moderate agreement (Spearman correlation coefficient, r = 0.40) between clinicians on the patient's probability of 30-day death or serious cardiac outcome, although as the probability increased, there was less agreement. CONCLUSIONS Acceptable agreement between raters was more commonly achieved with historical rather than physical examination or ECG interpretation variables. Clinicians had moderate agreement in assessing the patient's overall risk for a serious outcome at 30 days. Future development of clinical prediction models in older adults with syncope should account for variability of assessments between raters and consider the use of objective clinical variables.
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Affiliation(s)
- Daniel K. Nishijima
- Department of Emergency Medicine; UC Davis School of Medicine; Sacramento CA
| | - Amber L. Laurie
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine, Oregon Heath & Science University; Portland OR
| | - Robert E. Weiss
- Department of Biostatistics; Fielding School of Public Health; University of California; Los Angeles CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine, Oregon Heath & Science University; Portland OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine, Oregon Heath & Science University; Portland OR
| | - David H. Adler
- Department of Emergency Medicine; University of Rochester; Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine; William Beaumont Hospital-Troy; Troy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | - Carol L. Clark
- Department of Emergency Medicine; William Beaumont Hospital-Royal Oak; Royal Oak MI
| | - Deborah B. Diercks
- Department of Emergency Medicine; University of Texas-Southwestern; Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine; Thomas Jefferson University Hospital; Philadelphia PA
| | - Bret A. Nicks
- Department of Emergency Medicine; Wake Forest School of Medicine; Winston Salem NC
| | - Manish N. Shah
- Department of Emergency Medicine; University of Wisconsin-Madison; Madison WI
| | | | - Alan B. Storrow
- Department of Emergency Medicine; Vanderbilt University; Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine; Summa Health System; Akron OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine; Department of Emergency Medicine, Oregon Heath & Science University; Portland OR
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13
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Hersh WR, Campbell EM, Malveau SE. Assessing the feasibility of large-scale natural language processing in a corpus of ordinary medical records: a lexical analysis. Proc AMIA Annu Fall Symp 1997:580-4. [PMID: 9357692 PMCID: PMC2233467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Identify the lexical content of a large corpus of ordinary medical records to assess the feasibility of large-scale natural language processing. METHODS A corpus of 560 megabytes of medical record text from an academic medical center was broken into individual words and compared with the words in six medical vocabularies, a common word list, and a database of patient names. Unrecognized words were assessed for algorithmic and contextual approaches to identifying more words, while the remainder were analyzed for spelling correctness. RESULTS About 60% of the words occurred in the medical vocabularies, common word list, or names database. Of the remainder, one-third were recognizable by other means. Of the remaining unrecognizable words, over three-fourths represented correctly spelled real words and the rest were misspellings. CONCLUSIONS Large-scale generalized natural language processing methods for the medical record will require expansion of existing vocabularies, spelling error correction, and other algorithmic approaches to map words into those from clinical vocabularies.
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Affiliation(s)
- W R Hersh
- Division of Medical Informatics and Outcomes Research, Oregon Health Sciences University, USA
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