Emergency department management of syncope: need for standardization and improved risk stratification
| Autor: | Brian H. Rowe, Marco L.A. Sivilotti, Heather Murray, George A. Wells, Andrew D McRae, Lisa A. Calder, Eddy Lang, Venkatesh Thiruganasambandamoorthy, Ian G. Stiell, Monica Taljaard, Robert S. Sheldon, Aparna Vaidyanathan |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Referral Adolescent Clinical Decision-Making Psychological intervention Risk Assessment Syncope Young Adult Case mix index Outcome Assessment Health Care Internal Medicine medicine Humans Prospective Studies Practice Patterns Physicians' Intensive care medicine Prospective cohort study Aged Aged 80 and over business.industry Disposition Emergency department Middle Aged medicine.disease Prognosis Pulmonary embolism Risk perception Hospitalization ROC Curve Emergency medicine Emergency Medicine Female business Emergency Service Hospital |
| Zdroj: | Internal and emergency medicine. 10(5) |
| ISSN: | 1970-9366 |
| Popis: | Variations in emergency department (ED) syncope management have not been well studied. The goals of this study were to assess variations in management, and emergency physicians’ risk perception and disposition decision making. We conducted a prospective study of adults with syncope in six EDs in four cities over 32 months. We collected patient characteristics, ED management, disposition, physicians’ prediction probabilities at index presentation and followed patients for 30 days for serious outcomes: death, myocardial infarction (MI), arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage, or procedural interventions. We used descriptive statistics, ROC curves, and regression analyses. We enrolled 3662 patients: mean age 54.3 years, and 12.9 % were hospitalized. Follow-up data were available for 3365 patients (91.9 %) and 345 patients (10.3 %) suffered serious outcomes: 120 (3.6 %) after ED disposition including 48 patients outside the hospital. After accounting for differences in patient case mix, the rates of ED investigations and disposition were significantly different (p |
| Databáze: | OpenAIRE |
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