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Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis
- 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.
- Subjects :
- Male
Aging
medicine.medical_specialty
Leadership and Management
Clinical Sciences
030204 cardiovascular system & hematology
Assessment and Diagnosis
Cardiovascular
Logistic regression
Risk Assessment
Sensitivity and Specificity
Article
Syncope
Coronary artery disease
Hospital
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Clinical Research
General & Internal Medicine
Internal medicine
medicine
Humans
Prospective Studies
Prospective cohort study
Care Planning
Aged
Emergency Service
screening and diagnosis
business.industry
Health Policy
030208 emergency & critical care medicine
General Medicine
Emergency department
Middle Aged
medicine.disease
Detection
Heart Disease
Echocardiography
Heart failure
Predictive value of tests
Female
Fundamentals and skills
Observational study
Emergency Service, Hospital
business
4.2 Evaluation of markers and technologies
Cohort study
Subjects
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