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Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis

Authors :
Alan B. Storrow
Thomas A. Gibson
Daniel K. Nishijima
Christopher W. Baugh
Deborah B. Diercks
Susan Malveau
Bret A. Nicks
Jeffrey M. Caterino
Kirk A. Stiffler
Carol L. Clark
Annick N. Yagapen
Scott T. Wilber
Manish N. Shah
Benjamin C. Sun
David H. Adler
Judd E. Hollander
Marc A. Probst
Robert E. Weiss
Aveh Bastani
Source :
Journal of hospital medicine, vol 13, iss 12
Publication Year :
2018
Publisher :
Wiley, 2018.

Abstract

Background Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. Objective To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. Design Prospective, observational cohort study from April 2013 to September 2016. Setting Eleven EDs in the United States. Patients We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). Measurements The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. Results A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). Conclusions If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography. Registration ClinicalTrials.gov Identifier NCT01802398.

Details

ISSN :
15535606 and 15535592
Volume :
13
Database :
OpenAIRE
Journal :
Journal of Hospital Medicine
Accession number :
edsair.doi.dedup.....004dd35d1933498e1995ae25b0c0b6fe
Full Text :
https://doi.org/10.12788/jhm.3082