https://neomed.omeka.net/items/browse?tags=Syncope&output=atom2024-03-29T08:04:26-04:00Omekahttps://neomed.omeka.net/items/show/12202
Objective: The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies.
Methods: The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL IX only) and 30-day major adverse cardiovascular events (30d-MACE).
Results: Among 2560 patients in the BASEL IX and 2085 in SRS studies, ACC/AHA/HRS and ESC criteria recommended admission for a comparable number of patients in BASEL IX (27% vs 28%), but ACC/AHA/HRS criteria less often in SRS (19% vs 32%; P <.01). Recommendations were discordant in ∼25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines.
Conclusion: ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.]]>2023-01-13T15:38:19-05:00
Title
Performance of the American Heart Association/American College of Cardiology/Heart Rhythm Society versus European Society of Cardiology guideline criteria for hospital admission of patients with syncope
Creator
Jeanne du Fay de Lavallaz
Tobias Zimmermann
Patrick Badertscher
Pedro Lopez-Ayala
Thomas Nestelberger
Òscar Miró
Emilio Salgado
Xenia Zaytseva
Michele Sara Gafner
Michael Christ
Louise Cullen
Martin Than
F Javier Martin-Sanchez
Salvatore Di Somma
W Frank Peacock
Dagmar I Keller
Juan Pablo Costabel
Alan Sigal
Christian Puelacher
Desiree Wussler
Luca Koechlin
Ivo Strebel
Sereina Schuler
Robert Manka
Murat Bilici
Jens Lohrmann
Michael Kühne
Tobias Breidthardt
Carol L Clark
Marc Probst
Thomas A Gibson
Robert E Weiss
Benjamin C Sun
Christian Mueller
BASEL IX and SRS Investigators
Date
2022
Description
Background: Current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology (ESC) guidelines recommend different strategies to avoid low-yield admissions in patients with syncope.
Objective: The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies.
Methods: The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL IX only) and 30-day major adverse cardiovascular events (30d-MACE).
Results: Among 2560 patients in the BASEL IX and 2085 in SRS studies, ACC/AHA/HRS and ESC criteria recommended admission for a comparable number of patients in BASEL IX (27% vs 28%), but ACC/AHA/HRS criteria less often in SRS (19% vs 32%; P <.01). Recommendations were discordant in ∼25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines.
Conclusion: ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.
The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope.
Creator
Chang Anna Marie; Hollander Judd E; 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; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Sun Benjamin C
Publisher
The Journal of emergency medicine
Date
2020
2020-04-11
Description
BACKGROUND: McKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown. OBJECTIVE: We sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope. METHODS: We conducted a secondary analysis of a cohort study of adults >/=60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights. RESULTS: We analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 +/- 9.0 years. The median LOS was 32.6 h (interquartile range 24.2-71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9-63.6%) and the specificity was 47.8% (95% confidence interval 45.0-50.5%). CONCLUSIONS: In older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.
Variation in diagnostic testing for older patients with syncope in the emergency department
Creator
Su Erica; Nicks Bret A; Shah Manish N; Adler David H; Bastani Aveh; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Malveau Susan E; Nishijima Daniel K; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Yagapen Annick N; Weiss Robert E; Gibson Thomas A; Baugh Christopher W; Sun Benjamin C
Publisher
American Journal of Emergency Medicine
Date
2019
2019-05
Description
Background Older adults presenting with syncope often undergo intensive diagnostic testing with unclear benefit. We determined the variation, frequency, yield, and costs of tests obtained to evaluate older persons with syncope.
Subject
Cost; Diagnostic testing; Emergency department; Near syncope; Syncope; Variation; Yield