Predictors of 30-day serious events in older patients with syncope.
OBJECTIVE
We identify predictors of 30-day serious events after syncope in older adults.


METHODS
We reviewed the medical records of older adults (age > or =60 years) who presented with syncope or near syncope to one of 3 emergency departments (EDs) between 2002 and 2005. Our primary outcome was occurrence of a predefined serious event within 30 days after ED evaluation. We used multivariable logistic regression to identify predictors of 30-day serious events.


RESULTS
Of 3,727 potentially eligible patients, 2,871 (77%) met all eligibility criteria. We excluded an additional 287 patients who received a diagnosis of a serious clinical condition while in the ED. In the final study cohort (n=2,584), we identified 173 (7%) patients who experienced a 30-day serious event. High-risk predictors included age greater than 90 years, male sex, history of an arrhythmia, triage systolic blood pressure greater than 160 mm Hg, abnormal ECG result, and abnormal troponin I level. A low-risk predictor was a complaint of near syncope rather than syncope. A risk score, generated by summing high-risk predictors and subtracting the low-risk predictor, can stratify patients into low- (event rate 2.5%; 95% confidence interval [CI] 1.4% to 3.6%), intermediate- (event rate 6.3%; 95% CI 5.1% to 7.5%), and high-risk (event rate 20%; 95% CI 15% to 25%) groups.


CONCLUSIONS
We identified predictors of 30-day serious events after syncope in adults aged 60 years and greater. A simple score was able to stratify these patients into distinct risk groups and, if externally validated, might have the potential to aid ED decisionmaking.
Sun
Benjamin C
BC
Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. bsun@mednet.ucla.edu
Derose
Stephen F
SF
Liang
Li-Jung
LJ
Gabayan
Gelareh Z
GZ
Hoffman
Jerome R
JR
Moore
Alison A
AA
Mower
William R
WR
Mangione
Carol M
CM
D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology