Reasons for hospital admissions in low-risk syncope patients

Abstract

Reasons for hospital admissions in low-risk syncope patients

Background: Syncope is responsible for 1–3% of annual emergency department (ED) visits. The European Society of Cardiology (ESC) Syncope Guideline states that low-risk patients can be discharged from the ED. However, low-risk patients are still hospitalized for unknown reasons. Understanding admission reasons and contributing factors are crucial to improve syncope care in the ED. Aim: To describe reasons for hospital admissions and determine factors associated with unnecessary admissions in low-risk syncope patients visiting the ED. Method: Retrospective study with secondary analysis of the SYNERGY trial, which implemented the ESC Syncope Guideline in five Dutch hospitals. Eligible participants were ED visitors ≥18 years of age with low-risk syncope defined at one-year follow-up. The SYNERGY database was supplemented with variables from blinded medical letters of ED visits. Unnecessary admissions were defined if neither syncope, nor another condition gave reason for admission. Descriptive statistics were used for admission reasons and multivariate logistic regression for associated factors with unnecessary admissions. Results: From 521 patients enrolled in the SYNERGY study, 388 (74.5%) were low-risk and 153 (39.8%) were hospitalized. The predominant admission reason was to identify the syncope cause (unnecessary admission) (n=90), followed by underlying illness (n=38), illness unrelated to syncope (n=15), injury due to syncope (n=9) or social reason (n=1). Factors associated with unnecessary admissions were higher age (OR 1.02), findings and diagnostic evaluations unrelated to syncope (OR 8.66), ECG abnormalities (OR 3.38), measured orthostatic blood pressure (OR 0.33), low-risk syncopal circumstances (OR 0.33) or low-risk diagnosis made in the ED (OR 0.50). Telemetry monitoring was used in 96.7% unnecessary admissions. Conclusion: Unnecessary admissions with telemetry monitoring were high. Associated factors may be related to non-adherence to the Syncope Guideline. Practical implications: Better implementation of the Syncope Guideline is needed and nurses’ involvement in this should be considered.

Keywords: Syncope, Emergency Department, Hospitalization