Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope: A Multicenter Prospective Cohort Study

Title

Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope: A Multicenter Prospective Cohort Study

Creator

Thiruganasambandamoorthy V; Sivilotti M L A; Rowe B H; McRae A D; Mukarram M; Malveau S; Yagapen A N; Sun B C; Nemnom M J; Huang L; Taljaard M; Gaudet S; Kim S M; Adler D H; Bastani A; Baugh C W; Caterino J M; Clark C L; Diercks D B; Hollander J E; Nicks B A; Nishijima D K; Shah M N; Stiffler K A; Wilber S T; Storrow A B; North Amer Syncope Consortium

Publisher

Annals of Emergency Medicine

Date

2019
2019-05

Description

Study objective: The prevalence of pulmonary embolism among patients with syncope is understudied. In accordance with a recent study with an exceptionally high pulmonary embolism prevalence, some advocate evaluating all syncope patients for pulmonary embolism, including those with another clear cause for their syncope. We seek to evaluate the pulmonary embolism prevalence among emergency department (ED) patients with syncope. Methods: We combined data from 2 large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of pulmonary embolism-related investigations (ie, D-dimer, ventilation-perfusion scan, or computed tomography [CT] pulmonary angiography) and 30-day adjudicated outcomes: pulmonary embolism or nonpulmonary embolism outcome (arrhythmia, myocardial infarction, serious hemorrhage, and death). Results: Of the 9,374 patients enrolled, 9,091 (97.0%; median age 66 years, 51.9% women) with 30-day follow-up were analyzed: 547 (6.0%) were evaluated for pulmonary embolism (278 [3.1%] had D-dimer, 39 [0.4%] had ventilation-perfusion scan, and 347 [3.8%] had CT pulmonary angiography). Overall, 874 patients (9.6%) experienced 30-day serious outcomes: 818 patients (9.0%) with nonpulmonary embolism serious outcomes and 56 (prevalence 0.6%; 95% confidence interval 0.5% to 0.8%) with pulmonary embolism (including 8 [0.2%] out of 3521 patients diagnosed during the index hospitalization and 7 [0.1%] diagnosed after the index visit). Eighty-six patients (0.9%) died, and 4 deaths (0.04%) were related to pulmonary embolism. Only 11 patients (0.1%) with a nonpulmonary embolism serious condition had a concomitant pulmonary embolism. Conclusion: The prevalence of pulmonary embolism is very low among ED patients with syncope, including those hospitalized after syncope. Although an underlying pulmonary embolism may cause syncope, clinicians should be cautious about indiscriminate investigations for pulmonary embolism.

Subject

Emergency Medicine; guidelines; diagnostic-tests; yield; risk-stratification; short-term

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).

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Pages

500–510

Issue

5

Volume

73

ISSN

0196-0644

Citation

Thiruganasambandamoorthy V; Sivilotti M L A; Rowe B H; McRae A D; Mukarram M; Malveau S; Yagapen A N; Sun B C; Nemnom M J; Huang L; Taljaard M; Gaudet S; Kim S M; Adler D H; Bastani A; Baugh C W; Caterino J M; Clark C L; Diercks D B; Hollander J E; Nicks B A; Nishijima D K; Shah M N; Stiffler K A; Wilber S T; Storrow A B; North Amer Syncope Consortium, “Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope: A Multicenter Prospective Cohort Study,” NEOMED Bibliography Database, accessed June 13, 2021, https://neomed.omeka.net/items/show/6464.

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