Hospital vs. outpatient management comparable for elderly syncope patients


Background: In the United States, there are over 1 million visits to EDs for syncope with a greater than 50% hospitalization rate for older adult patients. There remains uncertainty around which patients without an identified cause for the syncope could be discharged from the ED and managed as an outpatient.

Dr. Halle Field, Ochsner Health System, New Orleans

Dr. Halle Field

Study design: Propensity score analysis.

Setting: EDs from 11 nonprofit academic hospitals.

Synopsis: Prospective data for 2,492 patients aged 60 years and older who did not have an identified cause in the ED for their presenting complaint of syncope were included in the propensity score analysis resulting in a sample size of 1,064 with 532 patients in each of the discharged and hospitalized groups. There was no significant difference in risk of 30-day post-ED serious adverse events between the hospitalized patients (4.89%; 95% confidence interval, 3.06%-6.72%) and discharged patients (2.82%; 95% CI, 1.41%-4.23%; risk difference 2.07%; 95% CI, –0.24% to 4.38%). There was also no statistically significant difference in 30-day mortality post–ED visit.

These results show no clinical benefit in hospitalization for older adults with unexplained syncope after ED evaluation suggesting that it would be reasonable to proceed with outpatient management and evaluation of these patients.

Bottom line: Consider discharging older patients home from the ED who do not have high risk factors and no identified cause of their syncope.

Citation: Probst MA et al. Clinical benefit of hospitalization for older adults with unexplained syncope: A propensity-matched analysis. Ann Emerg Med. 2019 Aug;74(2):260-9.

Dr. Field is a hospitalist at Ochsner Health System, New Orleans.

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