Risk stratification of adult emergency department syncope patients to predict short-term serious outcomes after discharge (RiSEDS) study

BMC Emergency Medicine

Volumn 14, Issue 1, 2014, Pages

  Thiruganasambandamoorthy, Venkatesh ^a,b,c   Stiell, Ian G ^a,b,c   Sivilotti, Marco L A ^d   Murray, Heather ^d   Rowe, Brian H ^e   Lang, Eddy ^f   McRae, Andrew ^f   Sheldon, Robert ^g   Wells, George A ^c  

^a UNIVERSITY OF OTTAWA   (Canada)

^b OTTAWA HOSPITAL RESEARCH INSTITUTE   (Canada)

^c UNIVERSITY OF OTTAWA   (Canada)

^d QUEEN S UNIVERSITY   (Canada)

^e UNIVERSITY OF ALBERTA   (Canada)

^f UNIVERSITY OF CALGARY   (Canada)

^g UNIVERSITY OF ALBERTA   (Canada)

Author keywords

Arrhythmia; Emergency department; Management; Prognosis; Serious outcomes; Syncope

Indexed keywords

ADULT; ADULT DISEASE; ADVERSE OUTCOME; AGED; AORTA DISSECTION; ARTICLE; CANADA; CLINICAL DECISION MAKING; COHORT ANALYSIS; DEATH; DISEASE SEVERITY; ELECTROCARDIOGRAM; EMERGENCY PHYSICIAN; EMERGENCY WARD; FAINTNESS; FEMALE; FOLLOW UP; HEAD INJURY; HEART ARRHYTHMIA; HEART DISEASE; HEART INFARCTION; HOSPITAL ADMISSION; HOSPITAL DISCHARGE; HUMAN; LOGISTIC REGRESSION ANALYSIS; LUNG EMBOLISM; MAJOR CLINICAL STUDY; MALE; MENTAL HEALTH; MULTICENTER STUDY; MULTIVARIATE ANALYSIS; PREDICTOR VARIABLE; PROSPECTIVE STUDY; PULMONARY HYPERTENSION; RISK FACTOR; SEIZURE; SUBARACHNOID HEMORRHAGE; UNCONSCIOUSNESS; UNIVARIATE ANALYSIS; VERY ELDERLY; BLOOD ANALYSIS; CONGENITAL HEART MALFORMATION; MULTICENTER STUDY (TOPIC); OBSERVATIONAL STUDY; PATIENT SAFETY; PRACTICE GUIDELINE; RISK ASSESSMENT; STATISTICAL SIGNIFICANCE;

ANEURYSM, DISSECTING; AORTIC ANEURYSM; ARRHYTHMIAS, CARDIAC; CANADA; EMERGENCY SERVICE, HOSPITAL; HEART DEFECTS, CONGENITAL; HEART FAILURE; HUMANS; HYPERTENSION, PULMONARY; MYOCARDIAL INFARCTION; PATIENT DISCHARGE; PRACTICE GUIDELINES AS TOPIC; PROGNOSIS; PROSPECTIVE STUDIES; PULMONARY EMBOLISM; RESEARCH DESIGN; RISK ASSESSMENT; RISK FACTORS; SUBARACHNOID HEMORRHAGE; SYNCOPE; TIME FACTORS;

EID: 84901985621     PISSN: None     EISSN: 1471227X     Source Type: Journal    
DOI: 10.1186/1471-227X-14-8     Document Type: Article

References (66)

1. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, Deharo JC, Gajek J, Gjesdal K, Krahn A, Massin M, Pepi M, Pezawas T, Granell RR, Sarasin F, Ungar A, Van DJ, Walma EP, Wieling W, Abe H, Benditt DG, Decker WW, Grubb BP, Kaufmann H, Morillo C, Olshansky B, Parry SW, Sheldon R, Shen WK, Vahanian A, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009, 30(21):2631-2671. Epub 2009 Aug 27 2009, 30(12), 3295536, 19713422.
2. Thiruganasambandamoorthy V, Hess EP, Turko E, Perry JJ, Wells GA, Stiell IG. Outcomes in Canadian emergency department syncope patients - are we doing a good job?. J Emerg Med 2013, 44(2):321-328. 10.1016/j.jemermed.2012.06.028, 23218198.
3. Blanc JJ, L'Her C, Touiza A, Garo B, L'Her E, Mansourati J. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002, 23(10):815-820. 10.1053/euhj.2001.2975, 12009722.
4. Sarasin FP, Louis-Simonet M, Carballo D, Slama S, Rajeswaran A, Metzger JT, Lovis C, Unger PF, Junod AF. Prospective evaluation of patients with syncope: a population-based study. Am J Med 2001, 111(3):177-184. 10.1016/S0002-9343(01)00797-5, 11530027.
5. Sun BC, Emond JA, Camargo CA. Characteristics and admission patterns of patients presenting with syncope to U.S. emergency departments, 1992-2000. Acad Emerg Med 2004, 11(10):1029-1034.
6. Kapoor WN. Evaluation and outcome of patients with syncope. Medicine 1990, 69(3):160-175.
7. Quinn JV, Stiell IG, McDermott DA, Sellers KL, Kohn MA, Wells GA. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med 2004, 43(2):224-232. 10.1016/S0196-0644(03)00823-0, 14747812.
8. Thiruganasambandamoorthy V, Hess EP, Alreesi A, Perry JJ, Wells GA, Stiell IG. External validation of the San Francisco Syncope Rule in the Canadian setting. Ann Emerg Med 2010, 55(5):464-472. 10.1016/j.annemergmed.2009.10.001, 19944489.
9. Quinn J, McDermott D, Stiell I, Kohn M, Wells G. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med 2006, 47(5):448-454. 10.1016/j.annemergmed.2005.11.019, 16631985.
10. Grossman SA, Fischer C, Lipsitz LA, Mottley L, Sands K, Thompson S, Zimetbaum P, Shapiro NI. Predicting adverse outcomes in syncope. J Emerg Med 2007, 33(3):233-239. 10.1016/j.jemermed.2007.04.001, 2276584, 17976548.
11. Reed MJ, Newby DE, Coull AJ, Prescott RJ, Jacques KG, Gray AJ. The ROSE (risk stratification of syncope in the emergency department) study. J Am Coll Cardiol 2010, 55(8):713-721. 10.1016/j.jacc.2009.09.049, 20170806.
12. Mendu ML, McAvay G, Lampert R, Stoehr J, Tinetti ME. Yield of diagnostic tests in evaluating syncopal episodes in older patients. Arch Intern Med 2009, 169(14):1299-1305. 3752785, 19636031.
13. Crane SD. Risk stratification of patients with syncope in an accident and emergency department. Emerg Med J 2002, 19(1):23-27. 10.1136/emj.19.1.23, 1725786, 11777866.
14. Sheldon RS, Morillo CA, Krahn AD, O'Neill B, Thiruganasambandamoorthy V, Parkash R, Talajic M, Tu JV, Seifer C, Johnstone D, Leather R. Standardized approaches to the investigation of syncope: Canadian Cardiovascular Society position paper. Can J Cardiol 2011, 27(2):246-253. 10.1016/j.cjca.2010.11.002, 21459273.
15. Serrano LA, Hess EP, Bellolio MF, Murad MH, Montori VM, Erwin PJ, Decker WW. Accuracy and quality of clinical decision rules for syncope in the emergency department: a systematic review and meta-analysis. Ann Emerg Med 2010, 56(4):362-373. e1, 10.1016/j.annemergmed.2010.05.013, 2946941, 20868906.
16. Day SC, Cook EF, Funkenstein H, Goldman L. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 1982, 73(1):15-23. 10.1016/0002-9343(82)90913-5, 7091170.
17. Martin GJ, Adams SL, Martin HG, Mathews J, Zull D, Scanlon PJ. Prospective evaluation of syncope. Ann Emerg Med 1984, 13(7):499-504. 10.1016/S0196-0644(84)80511-9, 6742551.
18. Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS. A prospective evaluation and follow-up of patients with syncope. N Engl J Med 1983, 309(4):197-204. 10.1056/NEJM198307283090401, 6866032.
19. Kapoor WN, Hanusa BH. Is syncope a risk factor for poor outcomes? Comparison of patients with and without syncope. Am J Med 1996, 100(6):646-655. 10.1016/S0002-9343(95)00052-6, 8678086.
20. Middlekauff HR, Stevenson WG, Stevenson LW, Saxon LA. Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol 1993, 21(1):110-116. 10.1016/0735-1097(93)90724-F, 8417050.
21. Ross J, Braunwald E. Aortic stenosis. Circulation 1968, 38(1 Suppl):61-67.
22. Eagle KA, Black HR. The impact of diagnostic tests in evaluating patients with syncope. Yale J Biol Med 1983, 56(1):1-8. 2589563, 6880244.
23. Ben-Chetrit E, Flugelman M, Eliakim M. Syncope: a retrospective study of 101 hospitalized patients. Isr J Med Sci 1985, 21(12):950-953.
24. Colivicchi F, Ammirati F, Melina D, Guido V, Imperoli G, Santini M, . OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 2003, 24(9):811-819. 10.1016/S0195-668X(02)00827-8, 12727148, OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators.
25. Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med 2008, 52(2):151-159. 10.1016/j.annemergmed.2007.12.007, 18282636.
26. Sun BC, Mangione CM, Merchant G, Weiss T, Shlamovitz GZ, Zargaraff G, Shiraga S, Hoffman JR, Mower WR. External validation of the San Francisco Syncope Rule. Ann Emerg Med 2007, 49(4):420-427. 10.1016/j.annemergmed.2006.11.012, 17210201.
27. Gallagher EJ. Hospitalization for fainting: high stakes, low yield. Ann Emerg Med 1997, 29(4):540-542.
28. Pires LA, Ganji JR, Jarandila R, Steele R. Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope. Arch Intern Med 2001, 161(15):1889-1895. 10.1001/archinte.161.15.1889, 11493131.
29. Mozes B, Confino-Cohen R, Halkin H. Cost-effectiveness of in-hospital evaluation of patients with syncope. Isr J Med Sci 1988, 24(6):302-306.
30. Simpson CS, Krahn AD, Klein GJ, Yee R, Skanes AC, Manda V, Norris C. A cost effective approach to the investigation of syncope: relative merit of different diagnostic strategies. Can J Cardiol 1999, 15(5):579-584.
31. Stiell IG, Greenberg GH, McKnight RD, Wells GA. Ottawa ankle rules for radiography of acute injuries. N Z Med J 1995, 108(996):111.
32. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001, 286(15):1841-1848. 10.1001/jama.286.15.1841, 11597285.
33. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001, 357(9266):1391-1396. 10.1016/S0140-6736(00)04561-X, 11356436.
34. Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn AA, Smith NA, Cacciotti TF, Sivilotti ML. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA 1996, 275(8):611-615. 10.1001/jama.1996.03530320035031, 8594242.
35. Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules. Applications and methodological standards. N Engl J Med 1985, 313(13):793-799. 10.1056/NEJM198509263131306, 3897864.
36. Stiell IG, Wells GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med 1999, 33(4):437-447. 10.1016/S0196-0644(99)70309-4, 10092723.
37. Laupacis A, Sekar N, Stiell IG. Clinical prediction rules: a review and suggested modifications of methodological standards. JAMA 1997, 277(6):488-494. 10.1001/jama.1997.03540300056034, 9020274.
38. Graham I, Stiell I, McAuley L. Potential areas for new clinical decision rules: comparison of North America and Europe [Abstract]. Acad Emerg Med 1999, 15(6):433.
39. Charlson ME, Ales KL, Simon R, MacKenzie CR. Why predictive indexes perform less well in validation studies. Is it magic or methods?. Arch Intern Med 1987, 147(12):2155-2161. 10.1001/archinte.1987.00370120091016, 3689067.
40. Poses RM, Cebul RD, Collins M, Fager SS. The importance of disease prevalence in transporting clinical prediction rules. The case of streptococcal pharyngitis. Ann Intern Med 1986, 105(4):586-591. 10.7326/0003-4819-105-4-586, 3530079.
41. Wigton RS, Connor JL, Centor RM. Transportability of a decision rule for the diagnosis of streptococcal pharyngitis. Arch Intern Med 1986, 146(1):81-83. 10.1001/archinte.1986.00360130103014, 3510600.
42. Lee TH. Evaluating decision aids: the next painful step. J Gen Intern Med 1990, 5(6):528-529. 10.1007/BF02600886, 2266437.
43. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med 1997, 29(4):459-466. 10.1016/S0196-0644(97)70217-8, 9095005.
44. Sarasin FP, Hanusa BH, Perneger T, Louis-Simonet M, Rajeswaran A, Kapoor WN. A risk score to predict arrhythmias in patients with unexplained syncope. Acad Emerg Med 2003, 10(12):1312-1317. 10.1111/j.1553-2712.2003.tb00003.x, 14644781.
45. Costantino G, Perego F, Dipaola F, Borella M, Galli A, Cantoni G, Dell'Orto S, Dassi S, Filardo N, Duca PG, Montano N, Furlan R, . STePS I Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (Short-Term Prognosis of Syncope) study. J Am Coll Cardiol 2008, 51(3):276-283. 10.1016/j.jacc.2007.08.059, 18206736, STePS I.
46. Del Rosso A, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart 2008, 94(12):1620-1626. 10.1136/hrt.2008.143123, 18519550.
47. Sun BC, Derose SF, Liang LJ, Gabayan GZ, Hoffman JR, Moore AA, Mower WR, Mangione CM. Predictors of 30-day serious events in older patients with syncope. Ann Emerg Med 2009, 54(6):769-778. e1-5, 10.1016/j.annemergmed.2009.07.027, 2788122, 19766355.
48. Huff JS, Decker WW, Quinn JV, Perron AD, Napoli AM, Peeters S, Jagoda AS, . American College of Emergency P Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med 2007, 49(4):431-444. 10.1016/j.annemergmed.2007.02.001, 17371707, American College of Emergency P.
49. Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Moya A, Raviele A, Sutton R, Theodorakis G, Wieling W, . Task Force on Syncope,European Society of Cardiology Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001, 22(15):1256-1306. 10.1053/euhj.2001.2739, 11465961, Task Force on Syncope,European Society of Cardiology.
50. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Masotti G, Moya A, Raviele A, Sutton R, Theodorakis G, Ungar A, Wieling W, . Task Force on Syncope,European Society of Cardiology Guidelines on management (diagnosis and treatment) of syncope--update 2004. Europace 2004, 6(6):467-537. Task Force on Syncope,European Society of Cardiology.
51. Del Greco M, Cozzio S, Scillieri M, Caprari F, Scivales A, Disertori M. Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. The ECSIT study (epidemiology and costs of syncope in Trento). Italian Heart Journal: Official Journal of the Italian Federation of Cardiology 2003, 4(2):99-106.
52. McCarthy F, McMahon CG, Geary U, Plunkett PK, Kenny RA, Cunningham CJ, . European Society of C Management of syncope in the Emergency Department: a single hospital observational case series based on the application of European Society of Cardiology Guidelines. Europace 2009, 11(2):216-224. European Society of C.
53. American College of Emergency Physicians Clinical policy: critical issues in the evaluation and management of patients presenting with syncope. Ann Emerg Med 2001, 37(6):771-776. American College of Emergency Physicians.
54. Elesber AA, Decker WW, Smars PA, Hodge DO, Shen WK, . American College of Emergency P Impact of the application of the American College of Emergency Physicians recommendations for the admission of patients with syncope on a retrospectively studied population presenting to the emergency department. Am Heart J 2005, 149(5):826-831. 10.1016/j.ahj.2004.07.024, 15894963, American College of Emergency P.
55. Thiruganasambandamoorthy V, Alreesi A, Hess E, Perry J, Wells G, Stiell I. Development of an improved rule to predict short-term serious outcomes in ED patients with syncope [abstract]. Acad Emerg Med 2009, 16:S5-S273.
56. Thiruganasambandamoorthy V, Hess EP, Turko E, Tran ML, Wells GA, Stiell IG. Defining abnormal electrocardiography in adult emergency department syncope patients: the Ottawa Electrocardiographic Criteria. CJEM Canadian J Emerg Med Care 2012, 14(4):248-258.
57. Kramer MS, Feinstein AR. Clinical biostatistics. LIV. The biostatistics of concordance. Clin Pharmacol Ther 1981, 29(1):111-123. 10.1038/clpt.1981.18, 7460469.
58. Donders AR, van der Heijden GJ, Stijnen T, Moons KG. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol 2006, 59(10):1087-1091. 10.1016/j.jclinepi.2006.01.014, 16980149.
59. Hosmer DW, Lemeshow S. Applied Logisitic Regression 2000, Hoboken, NJ, USA: Wiley.
60. Akaike H. A new look at statistical model identification. IEEE Transcations on Automatic Control 1974, 19(6):716-723.
61. Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Statist Sci 1986, 1(1):54-75.
62. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996, 49(12):1373-1379. 10.1016/S0895-4356(96)00236-3, 8970487.
63. Scheaffer RL, Mendenhall W, Ott L. Elementary Survey Sampling 1979, Belmont, CA, USA: Duxbury Press, 2.
64. Grossman SA, Babineau M, Burke L, Kancharla A, Mottley L, Nencioni A, Shapiro NI. Do outcomes of near syncope parallel syncope?. Am J Emerg Med 2012, 30(1):203-206. 10.1016/j.ajem.2010.11.001, 21185670.
65. Krahn AD, Klein GJ, Yee R, Skanes AC, REVEAL I. Predictive value of presyncope in patients monitored for assessment of syncope. Am Heart J 2001, 141(5):817-821. 10.1067/mhj.2001.114196, 11320372.
66. Garcia Reverte J, Llamas Lazaro C, Garcia Alberola A, Gomez Zapata M, Garcia Garcia R, Sanchez Munoz JJ, Martinez Sanchez J, Valdes Chavarri M. [Prognosis of presyncope in patients with structural heart disease]. Rev Esp Cardiol 2004, 57(7):629-634. 10.1016/S0300-8932(04)77163-8, 15274847.