title: Reasons for Hospitalization Among Emergency Department Patients With Syncope.
abstract: Variations in syncope management exist. Our objective was to identify the reasons for consultations and hospitalizations and outcomes among emergency department (ED) syncope patients.
  
  
  
  We conducted a prospective cohort study to enroll adult syncope patients at five EDs. We collected baseline characteristics, reasons for consultation and hospitalization, and hospital length of stay. Adjudicated 30-day serious adverse events (SAEs) including death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage, and procedural intervention. We used descriptive analysis.
  
  
  
  From 4,064 enrolled patients (mean ± SD age = 53.1 ± 23.2 years; 55.9% female), 3,255 (80.1%) were discharged directly by the ED physician. Of those with no SAEs identified in the ED (n = 600), 42.8% of referrals and 46.5% of hospitalizations were for suspected arrhythmias, and 71.2% of patients hospitalized for arrhythmias had no cause identified. SAEs among groups were 9.7% in total, 2.5% discharged by ED physician, 3.4% discharged by consultant, 21.7% as inpatient, and 4.8% following discharge from hospital. The median hospital length of stay for suspected arrhythmias was 5 days (interquartile range = 3 to 8 days).
  
  
  
  Cardiac syncope, particularly suspected arrhythmia, was the major reason for ED referrals and hospitalization. The majority of patients hospitalized for cardiac monitoring had no identified cause. An important number of patients suffered SAEs, particularly arrhythmias, outside the hospital. Development of a risk-stratification tool and out-of-hospital cardiac monitoring strategy should improve patient safety and save substantial resources.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario.|Ottawa Hospital Research Institute, Ottawa, Ontario.
authors.forename: Olivia G
authors.initials: OG
authors.lastname: Cook
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Mukarram
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario.|Ottawa Hospital Research Institute, Ottawa, Ontario.
authors.forename: Omair M
authors.initials: OM
authors.lastname: Rahman
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario.
authors.forename: Soo-Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario.
authors.forename: Kirtana
authors.initials: K
authors.lastname: Arcot
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario.|Institute of Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Kednapa
authors.initials: K
authors.lastname: Thavorn
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Department of Emergency Medicine and the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario.
authors.forename: Marco L A
authors.initials: ML
authors.lastname: Sivilotti
authors.affiliation: Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario.|Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Thiruganasambandamoorthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications; D018570:Risk Assessment; D013575:Syncope / Q000209:etiology* / Q000628:therapy