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40
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Text
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<a href="http://doi.org/10.12788/jhm.3082" target="_blank" rel="noreferrer noopener">http://doi.org/10.12788/jhm.3082</a>
Pages
823–828
Issue
12
Volume
13
Dublin Core
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Title
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Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis.
Publisher
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Journal of hospital medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
2018-12
Creator
An entity primarily responsible for making the resource
Probst Marc A; Gibson Thomas A; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Description
An account of the resource
BACKGROUND: Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. OBJECTIVE: To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. DESIGN: Prospective, observational cohort study from April 2013 to September 2016. SETTING: Eleven EDs in the United States. PATIENTS: We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). MEASUREMENTS: The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. RESULTS: A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T \textgreater14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide \textgreater125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). CONCLUSIONS: If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography. REGISTRATION: ClinicalTrials.gov Identifier NCT01802398.
Identifier
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<a href="http://doi.org/10.12788/jhm.3082" target="_blank" rel="noreferrer noopener">10.12788/jhm.3082</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
Adler David H
Bastani Aveh
Baugh Christopher W
Caterino Jeffrey M
Clark Carol L
Department of Emergency Medicine
Diercks Deborah B
Gibson Thomas A
Hollander Judd E
Journal of hospital medicine
Malveau Susan E
NEOMED College of Medicine
Nicks Bret A
Nishijima Daniel K
Probst Marc A
Shah Manish N
Stiffler Kirk A
Storrow Alan B
Sun Benjamin C
Weiss Robert E
Wilber Scott T
Yagapen Annick N
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.annemergmed.2019.08.429" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.annemergmed.2019.08.429</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
ISSN
1097-6760
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<a href="http://ezproxy.neomed.idm.oclc.org/login?url=http://doi.org/10.1016/j.annemergmed.2019.08.429" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1016/j.annemergmed.2019.08.429</a>
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Title
A name given to the resource
Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score
Publisher
An entity responsible for making the resource available
Annals Of Emergency Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-10-23
Creator
An entity primarily responsible for making the resource
Probst Marc A; Gibson Thomas; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Description
An account of the resource
STUDY OBJECTIVE: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. METHODS: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. RESULTS: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). CONCLUSION: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.
Identifier
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<a href="http://doi.org/10.1016/j.annemergmed.2019.08.429" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2019.08.429</a>
PMID: 31668571
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Journal Article
2019
Adler David H
Annals of emergency medicine
Bastani Aveh
Baugh Christopher W
Caterino Jeffrey M
Clark Carol L
Department of Emergency Medicine
Diercks Deborah B
Gibson Thomas
Hollander Judd E
Journal Article
Malveau Susan E
NEOMED College of Medicine
Nicks Bret A
Nishijima Daniel K
November 2019 Update
Probst Marc A
Shah Manish N
Stiffler Kirk A
Storrow Alan B
Summa Health System Akron City Hospital
Sun Benjamin C
Weiss Robert E
Wilber Scott T
Yagapen Annick N
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.annemergmed.2019.03.031" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.annemergmed.2019.03.031</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis
Publisher
An entity responsible for making the resource available
Annals of Emergency Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-05
Creator
An entity primarily responsible for making the resource
Probst Marc A; Su Erica; Weiss Robert E; Yagapen Annick N; Malveau Susan E; Adler David H; Bastani Aveh; Baugh Christopher W; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Description
An account of the resource
STUDY OBJECTIVE: Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. METHODS: We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. RESULTS: We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%). CONCLUSION: In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.annemergmed.2019.03.031" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2019.03.031</a>
2019
Adler David H
Annals of emergency medicine
Bastani Aveh
Baugh Christopher W
Caterino Jeffrey M
Clark Carol L
Department of Emergency Medicine
Diercks Deborah B
Hollander Judd E
June 2019 Update
Malveau Susan E
NEOMED College of Medicine
Nicks Bret A
Nishijima Daniel K
Probst Marc A
Shah Manish N
Stiffler Kirk A
Storrow Alan B
Su Erica
Sun Benjamin C
Weiss Robert E
Wilber Scott T
Yagapen Annick N