Does Hospital Admission Improve Detection of Serious Adverse Events After Syncope

Daniel D. Dressler, MD, MSc, MHM, FACP reviewing 

Maybe, but only in patients classified as high-risk based on the Canadian Syncope Risk Score.

Syncope might be a harbinger of a serious adverse event in ≈10% who present to emergency departments (EDs). Whether hospitalization after syncope leads to greater detection of such adverse events is unclear, leading to wide variations in admission rates. Investigators identified patients with syncope from two large prospective cohorts (>8000 patients at 11 Canadian hospitals): 650 patients who were admitted were propensity matched to 650 patients who were discharged directly from the ED. These researchers also assessed the Canadian Syncope Risk Score (CSRS) as a triage tool for hospital admission.

Compared with patients who were discharged from EDs, patients who were admitted had a significant fivefold increase in odds of a serious adverse event being detected. This difference was predominantly attributable to significantly higher detection of nonfatal arrhythmias (odds ratio, 5.1) or other nonarrhythmic serious conditions (OR, 6.3; e.g., bleeding, myocardial infarction, pulmonary embolism). Incidences of death and ventricular arrhythmias were not significantly different in hospitalized patients and discharged patients. Patients at low risk for adverse events based on CSRS showed the least benefit of admission (compared with patients at intermediate, high, or very high risk).

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