Do outcomes of near syncope parallel syncope?

• Published in: The American journal of emergency medicine Vol. 30; no. 1; pp. 203 - 206
• Main Authors: Grossman, Shamai A., MD, MS, Babineau, Mathew, MD, Burke, Laura, MD, Kancharla, Adarsh, MD, Mottley, Lawrence, MD, Nencioni, Andrea, MD, Shapiro, Nathan I., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Elsevier; Elsevier Limited
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bradycardia - epidemiology; Cardiac arrhythmia; Cardiopulmonary resuscitation; Chi-Square Distribution; Confidence intervals; Consciousness; CPR; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Hemorrhage - epidemiology; Hospitalization; Hospitalization - statistics & numerical data; Humans; Intensive care medicine; Intervention; Male; Medical sciences; Middle Aged; Myocardial Ischemia - epidemiology; Observational studies; Prospective Studies; Risk Factors; Sepsis; Studies; Syncope - diagnosis; Syncope - epidemiology; Teaching hospitals; Nervous system diseases; Intensive care; Prognosis; Syncope; Consciousness impairment; Neurological disorder; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.11.001

Abstract Background Limited information on the evaluation of emergency department (ED) patients complaining of “near syncope” exists. Multiple studies of syncope exclude near syncope claiming near syncope is poorly defined and its definition is nonuniform. Objective The aim of this study was to determine the incidence of critical interventions or adverse outcomes associated with near syncope and compare these outcomes with syncope. Methods Prospective, observational study enrolling (August 2007–October 2008) consecutive ED patients (age, ≥18 years) presenting with near syncope was conducted. Near syncope was defined as an episode in which the patient felt they might lose consciousness but did not. Critical intervention/adverse outcome was defined as hemorrhage, cardiac ischemia/intervention, alteration in antidysrhythmics, pacemaker/defibrillator placement, sepsis, stroke, death, dysrhythmia, sepsis, pulmonary embolus, or carotid stenosis. Primary outcome was an adverse outcome or critical intervention in hospital or less than 30 days. Near syncope and syncope outcomes and admission rates were compared using the χ2 test. Results After 1870 patients were screened, 244 met the study definition. Of the 244 patients, follow-up was achieved in 242 (99%). Emergency department hospitalization or 30-day adverse outcomes occurred in 49 (20%) of 244 compared with 68 (23%) of 293 of patients with syncope ( P = .40). The most common adverse outcomes/critical interventions were hemorrhage (n = 6), bradydysrhythmia (n = 6), alteration in antidysrhythmics (n = 6), and sepsis (n = 10). Of patients with near syncope, 49% were admitted compared with 69% with syncope ( P = .001). Conclusion Patients with near syncope are as likely those with syncope to experience critical interventions or adverse outcomes; however, near-syncope patients are less likely to be admitted. Given similar risk of adverse outcomes for near syncope and syncope, future studies are warranted to improve the treatment of ED patients with near syncope.