TY - JOUR
T1 - Prevalence of Pulmonary Embolism Among Emergency Department Patients With Syncope
T2 - A Multicenter Prospective Cohort Study
AU - North American Syncope Consortium
AU - Thiruganasambandamoorthy, Venkatesh
AU - Sivilotti, Marco L.A.
AU - Rowe, Brian H.
AU - McRae, Andrew D.
AU - Mukarram, Muhammad
AU - Malveau, Susan
AU - Yagapen, Annick N.
AU - Sun, Benjamin C.
AU - Nemnom, Marie Joe
AU - Huang, Longlong
AU - Taljaard, Monica
AU - Gaudet, Sarah
AU - Kim, Soo Min
AU - Adler, David H.
AU - Bastani, Aveh
AU - Baugh, Christopher W.
AU - Caterino, Jeffrey M.
AU - Clark, Carol L.
AU - Diercks, Deborah B.
AU - Hollander, Judd E.
AU - Nicks, Bret A.
AU - Nishijima, Daniel K.
AU - Shah, Manish N.
AU - Stiffler, Kirk A.
AU - Wilber, Scott T.
AU - Storrow, Alan B.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). The authors have stated that no such relationships exist. The study was funded by the Physicians’ Services Incorporated Foundation, Innovation Fund for Academic Health Sciences Centres of Ontario, through The Ottawa Hospital Academic Medical Organization, Canadian Institutes of Health Research , and the Cardiac Arrhythmia Network of Canada as part of the Networks of Centres of Excellence and by a grant from the National Heart, Lung, and Blood Institute (grant NIH R01 HL 111033 ). Dr. Thiruganasambandamoorthy holds a salary award National New Investigator Award through the Heart and Stroke Foundation of Canada . Dr. Rowe is supported by a Tier I Canada Research Chair in Evidence-based Emergency Medicine through the government of Canada (Ottawa, ON).
Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The study was funded by the Physicians? Services Incorporated Foundation, Innovation Fund for Academic Health Sciences Centres of Ontario, through The Ottawa Hospital Academic Medical Organization, Canadian Institutes of Health Research, and the Cardiac Arrhythmia Network of Canada as part of the Networks of Centres of Excellence and by a grant from the National Heart, Lung, and Blood Institute (grant NIH R01 HL 111033). Dr. Thiruganasambandamoorthy holds a salary award National New Investigator Award through the Heart and Stroke Foundation of Canada. Dr. Rowe is supported by a Tier I Canada Research Chair in Evidence-based Emergency Medicine through the government of Canada (Ottawa, ON). The authors acknowledge first all the emergency physicians at The Ottawa Hospital?Civic and General Campuses, Kingston General Hospital, Hotel Dieu Hospital, Foothills Medical Centre, and University of Alberta Hospital who recruited the patients and the emergency medicine residents who helped in this process; second, the following members of their research team: Ottawa site: Aline Christelle Ishimwe, My-Linh Tran, Sheryl Domingo, and Angela Marcantonio; Kingston site: Jane Reid, Vi Ho, Laura Goodfellow, Nicole O'Callaghan, and Vlad Latiu; and Edmonton site: Justin Lowes and Danielle DeVuyst; and third, all the emergency physicians and the research staff who enrolled patients for the Improving Syncope Risk Stratification study in the United States.
Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The study was funded by the Physicians’ Services Incorporated Foundation, Innovation Fund for Academic Health Sciences Centres of Ontario, through The Ottawa Hospital Academic Medical Organization, Canadian Institutes of Health Research, and the Cardiac Arrhythmia Network of Canada as part of the Networks of Centres of Excellence and by a grant from the National Heart, Lung, and Blood Institute (grant NIH R01 HL 111033). Dr. Thiruganasambandamoorthy holds a salary award National New Investigator Award through the Heart and Stroke Foundation of Canada. Dr. Rowe is supported by a Tier I Canada Research Chair in Evidence-based Emergency Medicine through the government of Canada (Ottawa, ON).
Publisher Copyright:
© 2018 American College of Emergency Physicians
PY - 2019/5
Y1 - 2019/5
N2 - Study objective: The prevalence of pulmonary embolism among patients with syncope is understudied. In accordance with a recent study with an exceptionally high pulmonary embolism prevalence, some advocate evaluating all syncope patients for pulmonary embolism, including those with another clear cause for their syncope. We seek to evaluate the pulmonary embolism prevalence among emergency department (ED) patients with syncope. Methods: We combined data from 2 large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of pulmonary embolism–related investigations (ie, D-dimer, ventilation-perfusion scan, or computed tomography [CT] pulmonary angiography) and 30-day adjudicated outcomes: pulmonary embolism or nonpulmonary embolism outcome (arrhythmia, myocardial infarction, serious hemorrhage, and death). Results: Of the 9,374 patients enrolled, 9,091 (97.0%; median age 66 years, 51.9% women) with 30-day follow-up were analyzed: 547 (6.0%) were evaluated for pulmonary embolism (278 [3.1%] had D-dimer, 39 [0.4%] had ventilation-perfusion scan, and 347 [3.8%] had CT pulmonary angiography). Overall, 874 patients (9.6%) experienced 30-day serious outcomes: 818 patients (9.0%) with nonpulmonary embolism serious outcomes and 56 (prevalence 0.6%; 95% confidence interval 0.5% to 0.8%) with pulmonary embolism (including 8 [0.2%] out of 3521 patients diagnosed during the index hospitalization and 7 [0.1%] diagnosed after the index visit). Eighty-six patients (0.9%) died, and 4 deaths (0.04%) were related to pulmonary embolism. Only 11 patients (0.1%) with a nonpulmonary embolism serious condition had a concomitant pulmonary embolism. Conclusion: The prevalence of pulmonary embolism is very low among ED patients with syncope, including those hospitalized after syncope. Although an underlying pulmonary embolism may cause syncope, clinicians should be cautious about indiscriminate investigations for pulmonary embolism.
AB - Study objective: The prevalence of pulmonary embolism among patients with syncope is understudied. In accordance with a recent study with an exceptionally high pulmonary embolism prevalence, some advocate evaluating all syncope patients for pulmonary embolism, including those with another clear cause for their syncope. We seek to evaluate the pulmonary embolism prevalence among emergency department (ED) patients with syncope. Methods: We combined data from 2 large prospective studies enrolling adults with syncope from 17 EDs in Canada and the United States. Each study collected the results of pulmonary embolism–related investigations (ie, D-dimer, ventilation-perfusion scan, or computed tomography [CT] pulmonary angiography) and 30-day adjudicated outcomes: pulmonary embolism or nonpulmonary embolism outcome (arrhythmia, myocardial infarction, serious hemorrhage, and death). Results: Of the 9,374 patients enrolled, 9,091 (97.0%; median age 66 years, 51.9% women) with 30-day follow-up were analyzed: 547 (6.0%) were evaluated for pulmonary embolism (278 [3.1%] had D-dimer, 39 [0.4%] had ventilation-perfusion scan, and 347 [3.8%] had CT pulmonary angiography). Overall, 874 patients (9.6%) experienced 30-day serious outcomes: 818 patients (9.0%) with nonpulmonary embolism serious outcomes and 56 (prevalence 0.6%; 95% confidence interval 0.5% to 0.8%) with pulmonary embolism (including 8 [0.2%] out of 3521 patients diagnosed during the index hospitalization and 7 [0.1%] diagnosed after the index visit). Eighty-six patients (0.9%) died, and 4 deaths (0.04%) were related to pulmonary embolism. Only 11 patients (0.1%) with a nonpulmonary embolism serious condition had a concomitant pulmonary embolism. Conclusion: The prevalence of pulmonary embolism is very low among ED patients with syncope, including those hospitalized after syncope. Although an underlying pulmonary embolism may cause syncope, clinicians should be cautious about indiscriminate investigations for pulmonary embolism.
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U2 - 10.1016/j.annemergmed.2018.12.005
DO - 10.1016/j.annemergmed.2018.12.005
M3 - Article
C2 - 30691921
AN - SCOPUS:85060432075
SN - 0196-0644
VL - 73
SP - 500
EP - 510
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 5
ER -