scholarly journals LO96: Syncope prognosis based on emergency department diagnosis: a prospective cohort study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S61 ◽  
Author(s):  
C. Toarta ◽  
M.A. Mukarram ◽  
K. Arcot ◽  
S. Kim ◽  
S. Gaudet ◽  
...  
Keyword(s):  
Emergency Department ◽  
Orthostatic Hypotension ◽  
Clinical Judgment ◽  
Vasovagal Syncope ◽  
Diagnostic Category ◽  
Structural Heart Disease ◽  
Patient Characteristics ◽  
Short Term ◽  
Major Trauma Patient ◽  
Cardiac Syncope

Introduction: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the 30-day serious outcomes among 4 diagnostic groups (vasovagal, orthostatic hypotension, cardiac, other/unknown) within 30 days of the index ED visit. Methods: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians’ confidence in assigning the etiology were collected. Serious outcomes at 30-days included: death, arrhythmia, myocardial infarction, structural heart disease, pulmonary embolism, and hemorrhage. Results: 5,010 patients (mean age 53.4 years; 54.8% females) were enrolled; 3.5% suffered serious outcomes: deaths (0.3%), arrhythmias (1.8%), non-arrhythmic cardiac (0.5%) and non-cardiac (0.9%). The cause of syncope was determined as vasovagal among 53.3% and cardiac in 5.4% of patients. The proportion of patients with ED investigations (p<0.001) and short-term serious outcomes increased (p<0.01) increased in each diagnostic category in the following order: vasovagal, orthostatic hypotension, other/unknown cause and cardiac. No deaths occurred in patients with vasovagal syncope. A higher proportion of all serious outcomes occurred among patients suspected of cardiac syncope in the ED (p<0.01). Confidence was highest among physicians for a vasovagal syncope diagnosis and lowest when the cause was other/unknown. Conclusion: Short-term serious outcomes strongly correlated with the etiology assigned in the ED visit. The physician’s clinical judgment should be incorporated in risk-stratification for prognostication and safe management of ED syncope patients.

scholarly journals Syncope of Obscure Nature

1979 ◽  
Vol 6 (1) ◽  
pp. 7-20 ◽  
Author(s):  
C. M. Fisher
Keyword(s):  
Abdominal Pain ◽  
Orthostatic Hypotension ◽  
Bowel Movement ◽  
Vasovagal Syncope ◽  
Anticonvulsant Therapy ◽  
Alcohol Ingestion ◽  
Loss Of Consciousness ◽  
Movement Response ◽  
Cardiac Syncope ◽  
Cold Drink

SummaryOne hundred and eleven cases of syncope or loss of consciousness are analyzed. Most are of obscure nature while some illustrate features of syncope that deserve further scrutiny. The cases are divided into six groups: 1) Resembling cardiac syncope (30 cases); 2) vasovagal syncope (22 cases); 3) features of both cardiac and vasovagal syncope (12 cases); 4) orthostatic hypotensive (29 cases); 5) akinetic seizure? (12 cases); and 6) miscellaneous (5 cases). Some groups are subdivided according to the circumstances surrounding the spells, for example, seated eating, nocturnal, associated with bowel movement, response to anticonvulsant therapy, etc. The following conclusions seem warranted: 1) The evidence favors the existence of a type of akinetic seizure resembling cardiac syncope; 2) loss of consciousness while seated eating (prandial syncope) may comprise a syndrome; 3) syncope related to bowel movement or abdominal pain is a striking association; 4)sporadic nocturnal syncope due to temporary hyp or e activity ofbaroreceptors is not sufficiently recognized; 5) alcohol ingestion may precipitate orthostatic hy-poreactivity of baroreceptors is not sufficiently recognized; 5) alcohol ingestion may precipitate orthostatic hypotension. Familial syncope, syncope proneness and cold drink syncope are illustrated.

Unexplained syncope: diagnostic value of tilt-table testing

1994 ◽  
Vol 3 (4) ◽  
pp. 322-325 ◽  
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Heart Disease ◽  
Diagnostic Tool ◽  
Clinical Judgment ◽  
Vasovagal Syncope ◽  
Structural Heart Disease ◽  
Diagnostic Value ◽  
Tilt Table ◽  
Erect Posture ◽  
Important Diagnostic Tool ◽  
Unexplained Syncope

Vasovagal syncope is a common syncope in patients who have no structural heart disease and occurs more often in young adults. It typically occurs in the erect posture, either standing or sitting. Upon recognition of the prodrome associated with NCS, subjects may avert syncope by lying down or putting the head between the knees. Use of head-up tilting is a recognized diagnostic tool and widely used for the evaluation of vasovagal syncope. However, cardiac diagnostic tests are not 100% accurate. This fact was recently underscored by what occurred in the recent tragic loss, due to ventricular fibrillation, of basketball star Reggie Lewis of the Boston Celtics. It is alleged that the tilt-table test was positive but that he also had structural heart disease. The most important diagnostic tool is the physician's clinical judgment.

scholarly journals Utility of a pediatric observation unit for the management of children admitted to the emergency department

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Antonio Gatto ◽  
Serena Rivetti ◽  
Lavinia Capossela ◽  
Davide Pata ◽  
Marcello Covino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
Abdominal Ultrasound ◽  
Term Treatment ◽  
Short Term ◽  
Short Term Treatment ◽  
Observation Units ◽  
Complex Patients ◽  
Laboratory Examinations

Abstract Background Observation Units (OU), as part of emergency department (ED), are areas reserved for short-term treatment or observation of patients with selected diagnoses to determine the need for hospitalization or home referral. Methods In this retrospective cohort study, we analyzed similarities and differences of children admitted to the pediatric ED of the Fondazione Policlinico Universitario A. Gemelli IRCCS hospital in the first 2 years of OU activity, analyzing general patient characteristics, access modalities, diagnosis, triage, laboratory and instrumental examinations, specialist visits, outcome of OU admission and average time spent in OU. Furthermore, we compared total numbers and type of hospitalization of the first 2 years of OU activity with those of previous 2 years. Results The most frequent diagnoses were abdominal pain, minor head injury without loss of consciousness, vomiting, epilepsy and acute bronchiolitis. The most performed laboratory examinations were blood count. The most commonly performed instrumental examination was abdominal ultrasound. Neurological counseling was the most commonly requested. Average time spent in OU was 13 h in 2016 and 14.1 h in 2017. Most OU admissions did not last longer than 24 h (90.5% in 2016 and 89.5% in 2017). In the years 2014–2015, 13.4% of pediatric patients accessing the ED were hospitalized, versus 9.9% the years 2016–2017 reducing pediatric hospital admissions by 3.6% (p <  0.001). Conclusions This study demonstrate that OU is a valid alternative to ordinary wards for specific pathologies. In accordance with the literature, our study showed that, in the first 2 years of the OU activity, admissions to hospital ward decreased compared with the previous 2 years with an increase of complex patients.

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

2021 ◽  
Author(s):  
Karoline Stentoft Rybjerg Larsen ◽  
Marianne Lisby ◽  
Hans Kirkegaard ◽  
Annemette Krintel Petersen
Keyword(s):  
Emergency Department ◽  
Electronic Patient Record ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Record Data ◽  
Emergency Department Patients ◽  
One Year ◽  
Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p&lt;0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p&lt;0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

scholarly journals Characteristics of Parkinson’s Disease in Patients with and without Cognitive Impairment

2021 ◽  
pp. 1-12
Author(s):  
Julie Chandler ◽  
Radhika Nair ◽  
Kevin Biglan ◽  
Erin A. Ferries ◽  
Leanne Munsie ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Emergency Department ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Memory Loss ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Newly Diagnosed ◽  
Comorbidity Burden

Background: Characterizing patients with Parkinson’s disease (PD) and cognitive impairment is important toward understanding their natural history. Objective: Understand clinical, treatment, and cost characteristics of patients with PD pre- and post-cognitive impairment (memory loss/mild cognitive impairment/dementia or dementia treatment) recognition. Methods: 2,711 patients with PD newly diagnosed with cognitive impairment (index) were identified using administrative claims data. They were matched (1:1) on age and gender to patients with PD and no cognitive impairment (controls). These two cohorts were compared on patient characteristics, healthcare resource utilization, and total median costs for 3 years pre- and post-index using Chi-square tests, t-tests, and Wilcoxon rank-sum tests. Logistic regression was used to identify factors predicting cognitive impairment. Results: Comorbidity indices for patients with cognitive impairment increased during the 6-year study period, especially after the index. Enrollment in Medicare Advantage Prescription Drug plans vs. commercial (OR = 1.60), dual Medicare/Medicaid eligibility (OR = 1.36), cerebrovascular disease (OR = 1.24), and PD medication use (OR = 1.46) were associated with a new cognitive impairment diagnosis (all p <  0.05). A greater proportion of patients with cognitive impairment had hospitalizations and emergency department visits and higher median total healthcare costs than controls for each year pre- and post-index. Conclusion: In patients with PD newly diagnosed with cognitive impairment, comorbidity burden, hospitalizations, emergency department visits, and total costs peaked 1-year pre- and post-identification. These data coupled with recommendations for annual screening for cognitive impairment in PD support the early diagnosis and management of cognitive impairment in order to optimize care for patients and their caregivers.

Predictors of short‐term hospitalization and emergency department presentations in aged care

2021 ◽  
Author(s):  
Maria C. Inacio ◽  
Robert N. Jorissen ◽  
Jyoti Khadka ◽  
Craig Whitehead ◽  
John Maddison ◽  
...  
Keyword(s):  
Emergency Department ◽  
Aged Care ◽  
Short Term
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