Benefit of hospital admission for detecting serious adverse events among emergency department patients with syncope: a propensity-score–matched analysis of a multicentre prospective cohort
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- Addressing the Achilles Heel of observational evidenceSara Hussain [MBChB, PhD]Posted on: 13 December 2020
- Posted on: (13 December 2020)Page navigation anchor for Addressing the Achilles Heel of observational evidenceAddressing the Achilles Heel of observational evidence
- Sara Hussain [MBChB, PhD], Family Medicine Resident, Clinician Investigator, McMaster University
We read with enthusiasm the report by Krishnan et al titled "Benefit of hospital admission for detecting serious adverse events among emergency department patients with syncope: a propensity-score–matched analysis of a multicentre prospective cohort." The authors demonstrated that patients who are admitted after presenting with syncope to the ER have increased odds ratio for serious adverse events in comparison to those who are discharged. This conclusion was mainly driven by non-fatal arrhythmia and non-arrhythmic serious conditions.
The authors based their analysis on 30-day outcomes. We are intrigued if these conclusions would be valid if 6 months or 1 year outcomes are available? The authors also alluded to judicial use of health resources; it would be interesting to examine the association between initial ER disposition and incidence of ER revisits for syncope.
The authors used a multi-variable logistic regression model that included CSRS score and other covariates to examine the interaction between CSRS score and disposition on the probability of serious adverse events. The authors concluded that CSRS can be used to support decision making. Despite the application of the CSRS score, it seems from this model that other clinical covariates (besides the patients’ social context) have to be taken into consideration when making decision on disposition.
In the study, 1983 eligible patients were not enrolled due to logistics of data collect...
Show MoreWe read with enthusiasm the report by Krishnan et al titled "Benefit of hospital admission for detecting serious adverse events among emergency department patients with syncope: a propensity-score–matched analysis of a multicentre prospective cohort." The authors demonstrated that patients who are admitted after presenting with syncope to the ER have increased odds ratio for serious adverse events in comparison to those who are discharged. This conclusion was mainly driven by non-fatal arrhythmia and non-arrhythmic serious conditions.
The authors based their analysis on 30-day outcomes. We are intrigued if these conclusions would be valid if 6 months or 1 year outcomes are available? The authors also alluded to judicial use of health resources; it would be interesting to examine the association between initial ER disposition and incidence of ER revisits for syncope.
The authors used a multi-variable logistic regression model that included CSRS score and other covariates to examine the interaction between CSRS score and disposition on the probability of serious adverse events. The authors concluded that CSRS can be used to support decision making. Despite the application of the CSRS score, it seems from this model that other clinical covariates (besides the patients’ social context) have to be taken into consideration when making decision on disposition.
In the study, 1983 eligible patients were not enrolled due to logistics of data collection. With nearly 20% of the eligible cohort not enrolled it is important to highlight the possibility of selection bias.
We would like to thank the authors for their efforts in conducting this study that will guide physicians in primary care when managing patients with syncope.
Show LessCompeting Interests: None declared.References
- 1. Krishnan R, Mukarram M, Ghaedi B, et al. Benefit of hospital admission for detecting serious adverse events among emergency department patients with syncope: a propensity-score–matched analysis of a multicentre prospective cohort. CMAJ 2020;192:E1198-E
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