Application of Syncope Guidelines in the Emergency Department Do Not Reduce Admission Rates: A Retrospective Cohort Study

Low-risk syncope accounts for a large proportion of hospital admissions; however, inpatient investigations are often not necessary and are rarely diagnostic. Reducing the number of low-risk syncope admissions can likely lower health care resource consumption and overall expenditure. Application of syncope guidelines by physicians in the emergency department provides a standardized approach that may potentially reduce admissions and lead to health care resource utilization savings. A retrospective chart review of 1229 syncope presentations was conducted at 2 major academic centres spanning 1 year. Three major society guidelines and position statements were applied to determine the effect on admission rates. A total of 1031 true syncope charts were included in the analysis; 407 (39%) were admitted and 624 (61%) were discharged by the treating physician (MD). There was a significant difference in the mean [standard deviation] age (75 [14] vs 55 [22]) and baseline cardiovascular disease, including congestive heart failure 51/407 (13%) vs 28/624 (5%), coronary artery disease 125/407 (31%) vs 91/624 (15%), and structural heart disease 36/407 (9%) vs 26/624 (4%), between admitted and not admitted patients, respectively (P < 0.01). All guidelines warranted more low-risk admissions when compared with 19% by the MD: Canadian Cardiovascular Society 34% (P < 0.01), American College of Emergency Physicians 22% (P = 0.03), and European Society of Cardiology 26% (P < 0.01). In conclusion, application of the current syncope guidelines to an emergency department population is unlikely to reduce low-risk hospital admissions. La syncope à faible risque représente une forte proportion des hospitalisations, alors que des examens en milieu hospitalier ne sont souvent pas nécessaires et permettent rarement de formuler un diagnostic. La réduction du nombre d’admissions pour une syncope à faible risque pourrait vraisemblablement diminuer la consommation des ressources en santé et les dépenses globales. La mise en application par les urgentologues de lignes directrices concernant la syncope constitue une approche normalisée qui pourrait permettre de réduire le nombre d’admissions et donc, l’utilisation des ressources en soins de santé. Une analyse rétrospective des dossiers médicaux de 1229 patients qui se sont présentés pour une syncope a été réalisée dans deux grands centres universitaires sur une période d’un an. Les lignes directrices et énoncés de position de trois grandes ass