Evaluating an Emergency Department Observation Syncope Protocol for Older Adults

Summary

Syncope, defined as a transient loss of consciousness, accounts for over 700,000 annual U.S. emergency department visits and may herald a life-threatening condition in older adults (age≥60 years). Existing risk prediction instruments cannot reliably identify who among such older patients can safely be discharged home from an emergency department. As a result, the majority of older patients without a clear cause for syncope are hospitalized for diagnostic evaluation. However, current admission practices are characterized by low diagnostic yield, do not clearly improve outcomes, and account for over $2.4 billion in annual hospital costs. Most admitted patients are discharged within 48 hours, and approximately 50% of patients do not have an identified cause of syncope after their hospitalization.

The implementation of an expedited and standardized Emergency Department Observation Syncope Protocol (EDOSP) may safely reduce hospitalization of older patients with syncope. The investigators propose a pilot randomized trial to implement and evaluate EDOSP at two emergency departments. This study has the following exploratory Specific Aims:

1. To compare admission rates and length-of-stay associated with EDOSP to standard care.
2. To compare serious outcomes rates associated with EDOSP to standard care.
3. To compare quality-of-life associated with EDOSP to standard care.
4. To compare the incremental costs and cost-effectiveness of EDOSP to standard care.

Over a one-year period, 120 intermediate-risk older adults who present with syncope at the two study sites will be randomized to 1 of 2 arms: 1.) intervention arm: expedited and standardized EDOSP care; or 2.) control arm: routine care consisting of admission from the emergency department.

If this pilot trial suggests that EDOSP can safely reduce admissions, then the investigators will plan a larger study powered to evaluate clinical, quality-of-life, and economic outcomes. A successful EDOSP intervention would have important clinical policy implications and improve the emergency department care of older adults with syncope.

Conditions

• Syncope

Interventions

OTHER

Emergency Department Observation Protocol

The EDOSP will consist of cardiac enzyme testing, 12-24 hours of cardiac monitoring, and echocardiogram testing by explicit criteria

OTHER

Unstructured, inpatient evaluation

This is unstructured management by an inpatient medical team.

Sponsors & Collaborators

• University of Southern California

  collaborator OTHER

• Brigham and Women's Hospital

  collaborator OTHER

• William Beaumont Hospitals

  collaborator OTHER

• Duke University

  collaborator OTHER

• National Institute on Aging (NIA)

  collaborator NIH

• University of California, Los Angeles

  lead OTHER

Principal Investigators

• Benjamin Sun, MD, MPP · University of California, Los Angeles

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

50 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2010-03-31

Primary Completion

2011-12-31

Completion

2011-12-31

Countries

• United States

Study Locations