title: Can elderly patients without risk factors be discharged home when presenting to the emergency department with syncope?
abstract: Age is often a predictor for morbidity and mortality. Although we previously proposed risk factors for adverse outcome in syncope, after accounting for the presence of these risk factors, it is unclear whether age is an independent risk factor for adverse outcomes in syncope. Our objective was to determine whether age is an independent risk factor for adverse outcome following a syncopal episode. We conducted a prospective, observational study enrolling consecutive patients with syncope. Adverse outcome/critical intervention included hemorrhage, myocardial infarction/percutaneous coronary intervention, dysrhythmia, antidysrhythmic alteration, pacemaker/defibrillator placement, sepsis, stroke, death, pulmonary embolus or carotid stenosis. Outcomes were identified by chart review and 30-day follow-up. We found that of 575 patients, adverse events occurred in 24%. Overall, 35% with risk factors had adverse outcomes compared to 1.6% without risks. Age ≥ 65 were more likely to have adverse outcomes: 34.5% versus 9.3%, p<0.001. Similarly, among patients with risk factors, elderly patients had more adverse outcomes: 43%; 36-50% versus 22%; 16-30%, p<0.001. However, among patients with no predefined risks, there were no statistical differences: 3.6%; 0.28-13% versus 1%; 0.04-3.8%. This was confirmed in a regression model accounting for the interaction between age>65 and risk factors. Although the elderly with syncope are at greater risk for adverse outcomes overall and in patients with risk factors, age ≥ 65 alone was not a predictor of adverse outcome in syncopal patients without risk factors. Based on this data, it may be safe to discharge home from the ED patients with syncope, but without risk factors, regardless of age.
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, United States. Electronic address: sgossma@bidmc.harvard.edu.
authors.forename: Shamai A
authors.initials: SA
authors.lastname: Grossman
authors.forename: David
authors.initials: D
authors.lastname: Chiu
authors.forename: Lewis
authors.initials: L
authors.lastname: Lipsitz
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Mottley
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013575:Syncope / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Age; Emergency; Risk factors; Syncope