title: Do patients with a negative Emergency Department evaluation for syncope require hospital admission?
abstract: Is hospitalization needed for patients in whom an underlying cause of syncope is not detected in the Emergency Department (ED)? To answer this question, we conducted a prospective, short-term outcomes study of consecutive patients > or = 50 years old presenting to our ED after a syncopal episode. All subjects received a structured ED evaluation. Forty-five patients met inclusion criteria, 67% were hospitalized. None of the patients experienced a life-threatening event or required significant therapeutic interventions during the hospitalization. No patient had a new diagnosis relevant to syncope. Follow-up interviews 1 month later revealed no repeat ED visits, hospitalizations, or deaths (95% upper CI, 6.5%). One patient reported a recurrent syncope (recurrence 2.2% [95% upper CI, 10%]). This pilot study suggests that a negative structured ED evaluation may identify patients > or = 50 years of age who may be safely discharged from the ED. Further validation is required before this observation is applied to clinical practice.
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Rumm M
authors.initials: RM
authors.lastname: Morag
authors.forename: Linette F
authors.initials: LF
authors.lastname: Murdock
authors.forename: Zaber A
authors.initials: ZA
authors.lastname: Khan
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Heller
authors.forename: Barry E
authors.initials: BE
authors.lastname: Brenner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003955:Diagnostic Tests, Routine; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D013575:Syncope / Q000175:diagnosis* / Q000628:therapy