Abstract
Study objective: Emergency department (ED) visits for syncope are common and routine diagnostic testing is frequently low yield. Our objective is to determine whether recent guidelines emphasizing limiting hospitalization and advanced diagnostic testing to high-risk patients have changed patterns of syncope care. Methods: This was a retrospective population epidemiology study of syncope-related ED visits and hospitalizations using the National Emergency Department Sample from 2006 to 2014 and the State Inpatient Databases and Emergency Department Databases from 2009 and 2013. Primary outcomes were annual incidence rates of syncope ED visits and subsequent hospitalizations, and rates of hospitalization, observation, 30-day revisits, and diagnostic testing comparing 2009 with 2013. Differences were estimated with multivariable logistic regression modeling adjusted for patient clinical and demographic characteristics. Results: From 2006 to 2014, we identified 15,154,920 survey-weighted ED visits for syncope. Annual rates of ED visits increased from 643 to 771 per 100,000 adults, whereas hospitalizations declined from 36.3% to 24.7% (–11.6% absolute difference; 95% confidence interval [CI] –13.0% to –10.2%). In multistate adjusted analyses, the proportion of ED visits resulting in hospital admission decreased 11.7% (95% CI –11.9% to –11.6%) between 2009 and 2013, whereas the proportion of ED visits resulting in observation care increased by 7.9% (95% CI 7.8% to 8.0%), with no significant change in 30-day ED revisit rates (absolute difference 0.1%; 95% CI –0.1% to 0.3%). The frequency of advanced cardiac testing increased from 13.8% to 17.0%, and neuroimaging increased from 40.6% to 44.3%, driven by increased testing of patients receiving observation and inpatient care. Conclusion: Although the incidence of ED visits for syncope has increased, hospitalization rates have declined, without an adverse effect on ED revisits, possibly because of increased use of observation care. Use of advanced cardiac testing and neuroimaging has increased, driven by growth in testing of patients receiving observation and inpatient care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 523-532 |
| Number of pages | 10 |
| Journal | Annals of Emergency Medicine |
| Volume | 72 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2018 |
| Externally published | Yes |
Bibliographical note
Funding Information:Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The study was funded by the Mount Zion Health Fund (grant 20160945) awarded to Dr. Anderson through the University of California, San Francisco Resource Allocation Program. Dr. Anderson is supported by a training grant from the National Research Service Award (NRSA T32HP19025-14-00).
Publisher Copyright:
© 2018 American College of Emergency Physicians