Outcomes of Patients With Syncope and Suspected Dementia
- PMID: 29575587
- PMCID: PMC6156993
- DOI: 10.1111/acem.13414
Outcomes of Patients With Syncope and Suspected Dementia
Abstract
Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia.
Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death.
Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days.
Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
© 2018 by the Society for Academic Emergency Medicine.
Conflict of interest statement
TRH reports no conflict of interest
MNS reports no conflict of interest
TAG reports no conflict of interest
REW reports no conflict of interest
ANY reports no conflict of interest
SEM reports no conflict of interest
DHA reports no conflict of interest
AB reports no conflict of interest
CWB reports no conflict of interest
JMC reports no conflict of interest
CLC reports no conflict of interest
DBD reports no conflict of interest
JEH reports no conflict of interest
BAN reports no conflict of interest
DKN reports no conflict of interest
KAS reports no conflict of interest
ABS reports no conflict of interest
STW reports no conflict of interest
BCS reports no conflict of interest
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