Assessment of a structured management pathway for patients referred to the Emergency Department for syncope: results in a tertiary hospital.

Autor:	Ungar A; Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy aungar@unifi.it., Tesi F; Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy., Chisciotti VM; Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy., Pepe G; Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy., Vanni S; Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy., Grifoni S; Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy., Balzi D; Epidemiology Unit, Local Health 10, Florence, Italy., Rafanelli M; Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy., Marchionni N; Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy., Brignole M; Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2016 Mar; Vol. 18 (3), pp. 457-62. Date of Electronic Publication: 2015 May 14.
DOI:	10.1093/europace/euv106
Abstrakt:	Aims: High hospitalization rates (39-58% in the literature) of patients admitted to Emergency Department (ED) for transient loss of consciousness (T-LOC) suspected for syncope are still an unresolved issue. The presence of an Observation Unit has reduced hospital admissions and the duration of hospitalization in controlled studies, and a Syncope Unit (SU) in the hospital may reduce hospitalization and increase the number of diagnoses in patients with T-LOC. We assessed the effect of a structured organization on hospitalization rate and outcome. Methods and Results: Consecutive patients referred to the ED for a T-LOC of a suspected syncopal nature as the main diagnosis were included. The ED physician was trained to choose between: hospital admission (directly or after short observation); discharge after short (<48-h) observation; discharge on a fast track to the SU; and direct discharge without any further diagnostics. From January to June 2010, 362 patients were evaluated in the ED: 29% were admitted, 20% underwent short observation in the ED, 20% were referred to the SU, and 31% were directly discharged. Follow-up data were available on 295 patients who were discharged alive: of these, 1 (0.3%) previously hospitalized patient died within 30 days and 16 (5.4%) died within 1 year. Death rates were 12.9, 3.3, 0, and 2.5% among admitted, observation, SU, and ED-discharged patients, respectively. No death could be directly attributed to T-LOC. Re-admission within 1 year for any cause occurred in 72 (24%) patients; re-admission rates were 45.9, 19.3, 11.5, and 18.0% among admitted, observation, SU, and ED-discharged patients, respectively. Conclusions: The availability of short observation and a SU seems to reduce the hospitalization rate compared with previous reported historical reports from our and other centres. Most deaths during follow-up occurred in patients who had been hospitalized. High rates of re-admission to the ED within 1 year are still an issue. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu