Key result
ED observation for unexplained syncope yields high diagnosis rates with ~3% short-term serious outcomes.
Why the study?
Does management in standardized emergency department observation units improve diagnostic yield and reduce admissions safely in patients with unexplained syncope?
Meta-Analysis (n=458)
Does management in standardized emergency department observation units improve diagnostic yield and reduce admissions safely in patients with unexplained syncope?
Emergency department observation units offer a safe and effective strategy for managing unexplained syncope, yielding a high etiological diagnosis rate (67.3%) with low admission rates (18.5%) and short-term serious outcomes (2.8%).
Supports standardized ED observation units for unexplained syncope to raise diagnostic yield while curbing admissions and risks; extends meta-analytic support for protocol-driven management.
This meta-analysis aimed to establish the role of standardized emergency department (ED) observation protocols in the management of syncopal patients as an alternative to ordinary admission. A systematic electronic literature search was performed to identify randomized controlled trials or observational studies evaluating syncopal patients managed in ED observation units. Data regarding mean length of stay, rate of etiological diagnosis, admission rate, and incidence of short-term serious outcomes were extracted. Six mostly single-center, small sized studies characterized by high heterogeneity, were included. A total of 458 patients were included with a balanced sex distribution (male 50.2%), a mean age of 60.1 years, and a considerable prevalence of heart disease (32.4%). Pooled analysis of the outcomes showed a mean stay of 28.2 hours, an etiological diagnosis rate of 67.3%, an admission rate of 18.5%, and a very low incidence of short-term serious outcomes (2.8%). Due to elevated diagnostic yield and low incidence of short-term adverse events, ED observation units-based management strategy seems ideal for patients with syncope. Nevertheless, further research is needed to identify criteria for selecting patients to be managed with this approach, define evaluation protocols, and confirm the safety of this strategy.
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Numeroso et al. (2017) conducted a meta-analysis in Unexplained syncope (n=458). Emergency department observation unit (EDOU) protocols vs. Ordinary admission was evaluated on Short-term serious outcomes (95% CI 0.4-7.2). Emergency department observation unit protocols for unexplained syncope yielded a 67.3% etiological diagnosis rate, an 18.5% admission rate, and a low 2.8% incidence of short-term serious outcomes.
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