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Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Published online by Cambridge University Press:  04 March 2015

Venkatesh Thiruganasambandamoorthy ,
George A. Wells ,
Erik P. Hess ,
Ekaterina Turko ,
Jeffrey J. Perry  and
Ian G. Stiell
Venkatesh Thiruganasambandamoorthy*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
George A. Wells
Affiliation:
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
Erik P. Hess
Affiliation:
Division of Emergency Medicine Research, Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
Ekaterina Turko
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON
Jeffrey J. Perry
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, ON The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
*
Ottawa Health Research Institute, Clinical Epidemiology Unit, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, 6th Floor, Room F655, Ottawa, ON K1Y 4E9; vthirug@ohri.ca

Abstract

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Background:

Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days.

Methods:

We conducted a medical record review to include syncope patients age ≥ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/ monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed.

Results:

Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age ≥ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure < 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen > 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0–10) was found to accurately stratify patients into low risk (score < 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score > 1, ≥ 10% SAE risk).

Conclusion:

We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this will be a potentially useful clinical decision tool for emergency physicians, may allow judicious use of health care resources, and may improve patient care and safety.

Keywords

emergency departmentrisk scaleserious adverse eventsyncope
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 2 , March 2014 , pp. 120 - 130
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

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