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. 2021 Jun:44:62-67.
doi: 10.1016/j.ajem.2021.01.042. Epub 2021 Feb 4.

Regional variation in outcomes and healthcare resources utilization in, emergency department visits for syncope

Waseem Khaliq  1 , Moeen Aboabdo  2 , Che Matthew Harris  3 , Noor Bazerbashi  4 , Eric Moughames  1 , Nour Al Jalbout  5 , Karim Hajjar  6 , Hind A Beydoun  7 , May A Beydoun  8 , Shaker M Eid  1
Affiliations

Regional variation in outcomes and healthcare resources utilization in, emergency department visits for syncope

Waseem Khaliq et al. Am J Emerg Med. 2021 Jun.

Abstract

Background: Management of patients with syncope lacks standardization. We sought to assess regional variation in hospitalization rates and resource utilization of patients with syncope.

Methods: We identified adults with syncope using the Nationwide Emergency Department Sample from years 2006 to 2014. Demographics and comorbidity characteristics were compared across geographic regions in the US. Multiple regression was conducted to compare outcomes.

Results: 9,132,176 adults presented with syncope. Syncope in the Northeast (n = 1,831,889) accounted for 20.1% of visits; 22.6% in the Midwest (n = 2,060,940), 38.5% in the South (n = 3,527,814) and 18.7% in the West (n = 1,711,533). Mean age was 56 years with 57.7% being female. The Northeast had the highest risk-adjusted hospitalization rate (24.5%) followed by the South (18.6%, ORadj 0.58; 95% CI 0.52-0.65, p < 0.001), the Midwest (17.2%, ORadj 0.51; 95% CI 0.46-0.58, p < 0.001) and West (15.8%, ORadj 0.45; 95% CI 0.39-0.51, p < 0.001). Risk-adjusted rates of syncope hospitalizations significantly declined from 25.8% (95% CI 24.8%-26.7%) in 2006 to 11.7% (95% CI 11.0%-12.5%) in 2014 (Ptrend < 0.001). The Northeast had the lowest risk-adjusted ED (Emergency Department) service charges per visit ($3320) followed by the Midwest ($4675, IRRadj 1.41; 95% CI 1.30-1.52, p < 0.001), the West ($4814, IRRadj 1.45; 95% CI 1.31-1.60, p < 0.001) and South ($4969, IRRadj 1.50; 95% CI 1.38-1.62, p < 0.001). Service charges increased from $3047/visit (95% CI $2912-$3182) in 2006 to $6267/visit (95% CI $5947-$6586) in 2014 (Ptrend < 0.001).

Conclusions: Significant regional variability in hospitalization rates and ED service charges exist among patients with syncope. Standardizing practices may be needed to reduce variability.

Keywords: Emergency department; Large database; Regional variation; Syncope.

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Conflict of interest statement

Conflict of Interest: All authors report no conflict of interest germane to this paper.

Figures

Fig. 1A:
Fig. 1A:. Risk-adjusted Hospitalization Rate for Syncope by Region United States 2006-2014
Fig. 1B:
Fig. 1B:. Risk-adjusted ED Service Charges for Syncope by Region United States 2006-2014
Fig. 2A:
Fig. 2A:. Overall Trend in Risk-adjusted Syncope Hospitalization United States 2006-2014
OR: 0.85 95% CI [0.84-0.86], p<0.001
Fig. 2B:
Fig. 2B:. Trend in Risk-adjusted Syncope Hospitalization By Region United States 2006-2014
NE -- OR: 0.85 95% CI [0.83-0.88], p<0.001 MW -- OR: 0.88 95% CI [0.86-0.89], p<0.001 S -- OR: 0.85 95% CI [0.83-0.86], p<0.001 W -- OR: 0.84 95% CI [0.82-0.87], p<0.001
Fig. 2C:
Fig. 2C:. Overall Trend in Adjusted ED Service Charges United States 2006-2014
IRR: 1.10 95% CI [1.09-1.10], p<0.001
Fig. 2D:
Fig. 2D:. Trend in Adjusted ED Service Charges By Region United States 2006-2014
NE -- IRR: 1.11 95% CI [1.09-1.12], p<0.001 MW -- IRR: 1.07 95% CI [1.06-1.08], p<0.001 S -- IRR: 1.09 95% CI [1.08-1.11], p<0.001 W -- IRR: 1.15 95% CI [1.12-1.17], p<0.001
Fig. 3:
Fig. 3:. Syncope Disposition From the ED by Region United States 2006-2014
See this image and copyright information in PMC

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