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Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission.

Publication ,  Journal Article
Sun, BC; McCreath, H; Liang, L-J; Bohan, S; Baugh, C; Ragsdale, L; Henderson, SO; Clark, C; Bastani, A; Keeler, E; An, R; Mangione, CM
Published in: Ann Emerg Med
August 2014

STUDY OBJECTIVE: Older adults are frequently hospitalized from the emergency department (ED) after an episode of unexplained syncope. Current admission patterns are costly, with little evidence of benefit. We hypothesize that an ED observation syncope protocol will reduce resource use without adversely affecting patient-oriented outcomes. METHODS: This randomized trial at 5 EDs compared an ED observation syncope protocol to inpatient admission for intermediate-risk adults (≥50 years) presenting with syncope or near syncope. Primary outcomes included inpatient admission rate and length of stay. Secondary outcomes included 30-day and 6-month serious outcomes after hospital discharge, index and 30-day hospital costs, 30-day quality-of-life scores, and 30-day patient satisfaction. RESULTS: Study staff randomized 124 patients. Observation resulted in a lower inpatient admission rate (15% versus 92%; 95% confidence interval [CI] difference -88% to -66%) and shorter hospital length of stay (29 versus 47 hours; 95% CI difference -28 to -8). Serious outcome rates after hospital discharge were similar for observation versus admission at 30 days (3% versus 0%; 95% CI difference -1% to 8%) and 6 months (8% versus 10%; 95% CI difference -13% to 9%). Index hospital costs in the observation group were $629 (95% CI difference -$1,376 to -$56) lower than in the admission group. There were no differences in 30-day quality-of-life scores or in patient satisfaction. CONCLUSION: An ED observation syncope protocol reduced the primary outcomes of admission rate and hospital length of stay. Analyses of secondary outcomes suggest reduction in index hospital costs, with no difference in safety events, quality of life, or patient satisfaction. Our findings suggest that an ED observation syncope protocol can be replicated and safely reduce resource use.

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Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

August 2014

Volume

64

Issue

2

Start / End Page

167 / 175

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Syncope
  • Quality of Life
  • Patient Satisfaction
  • Patient Outcome Assessment
  • Patient Discharge
  • Patient Admission
  • Middle Aged
  • Male
  • Length of Stay
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sun, B. C., McCreath, H., Liang, L.-J., Bohan, S., Baugh, C., Ragsdale, L., … Mangione, C. M. (2014). Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission. Ann Emerg Med, 64(2), 167–175. https://doi.org/10.1016/j.annemergmed.2013.10.029
Sun, Benjamin C., Heather McCreath, Li-Jung Liang, Stephen Bohan, Christopher Baugh, Luna Ragsdale, Sean O. Henderson, et al. “Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission.Ann Emerg Med 64, no. 2 (August 2014): 167–75. https://doi.org/10.1016/j.annemergmed.2013.10.029.
Sun BC, McCreath H, Liang L-J, Bohan S, Baugh C, Ragsdale L, et al. Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission. Ann Emerg Med. 2014 Aug;64(2):167–75.
Sun, Benjamin C., et al. “Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission.Ann Emerg Med, vol. 64, no. 2, Aug. 2014, pp. 167–75. Pubmed, doi:10.1016/j.annemergmed.2013.10.029.
Sun BC, McCreath H, Liang L-J, Bohan S, Baugh C, Ragsdale L, Henderson SO, Clark C, Bastani A, Keeler E, An R, Mangione CM. Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission. Ann Emerg Med. 2014 Aug;64(2):167–175.
Journal cover image

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

August 2014

Volume

64

Issue

2

Start / End Page

167 / 175

Location

United States

Related Subject Headings

  • Watchful Waiting
  • Syncope
  • Quality of Life
  • Patient Satisfaction
  • Patient Outcome Assessment
  • Patient Discharge
  • Patient Admission
  • Middle Aged
  • Male
  • Length of Stay