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

Venkatesh Thiruganasambandamoorthy, George A. Wells, Erik P. Hess, Ekaterina Turko, Jeffrey J. Perry, Ian G. Stiell

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)120-130
Number of pages11
JournalCanadian Journal of Emergency Medicine
Volume16
Issue number2
DOIs
StatePublished - 2014

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Syncope
Hospital Emergency Service
Blood Pressure
Unconsciousness
Vital Signs
Health Resources
Blood Urea Nitrogen
Street Drugs
Emergency Medical Services
Patient Safety
Craniocerebral Trauma
Routine Diagnostic Tests
Dyspnea
Medical Records
Comorbidity
Patient Care
Electrocardiography
Seizures
Emergencies
Logistic Models

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients. / Thiruganasambandamoorthy, Venkatesh; Wells, George A.; Hess, Erik P.; Turko, Ekaterina; Perry, Jeffrey J.; Stiell, Ian G.

In: Canadian Journal of Emergency Medicine, Vol. 16, No. 2, 2014, p. 120-130.

Research output: Contribution to journalArticle

Thiruganasambandamoorthy, Venkatesh ; Wells, George A. ; Hess, Erik P. ; Turko, Ekaterina ; Perry, Jeffrey J. ; Stiell, Ian G. / Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients. In: Canadian Journal of Emergency Medicine. 2014 ; Vol. 16, No. 2. pp. 120-130.
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abstract = "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.",
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