Does Chart State Why Syncope Patient Was Deemed Low Risk?
An otherwise healthy patient suddenly falls unconscious. This dramatic presentation can cloud the fact patients who present to EDs with syncope generally are low risk.
“Physicians sometimes just don’t trust their judgment, especially in high-risk medical-legal climates,” observes James Quinn, MD, a professor of emergency medicine at Stanford.
Quinn and colleagues assessed the rate of adverse events in ED patients with syncope at 24 hours (5.1%), 72 hours (7%), seven to 10 days (8.4%), one month (10.3%), and one year (21.3%) after the evaluation.1 “Most cases of syncope are benign but can be associated with arrhythmia and death. Fortunately, as these studies show, most of these patients can be predicted,” Quinn says.
Quinn and colleagues analyzed nine studies that included 12,269 syncope patients presenting to EDs. They found risk of death or life-threatening adverse events are rare. Brady and supraventricular arrhythmias were the most common adverse events, which occurred during the first three days after the ED visits.
Prolonged ECG monitoring in the ED, in an observation unit followed by ambulatory monitoring, can mitigate risks for intermediate- and higher-risk patients. “Many low-risk patients are still admitted at significant cost,” Quinn notes. “Over time, the number has declined with clinical decision support.”
If the EP is discharging a patient with syncope, Quinn says documenting reasons why he or she believes the patient is low risk is important. These include the absence of cardiovascular risks (especially congestive heart failure), the absence of pulmonary embolism risk factors, the absence of family risk of sudden death, and a normal ECG.
“Most physicians have good judgment,” Quinn offers. “When they augment it with clinical decision guidelines, they can minimize any liability and medical/legal risk.”
REFERENCE
- Furlan L, Trombetta L, Casazza G, et al. Syncope time frames for adverse events after emergency department presentation: An individual patient data meta-analysis. Medicina (Kaunas) 2021;57:1235.
Prolonged ECG monitoring in the ED, in an observation unit followed by ambulatory monitoring, can mitigate risks for intermediate- and higher-risk patients.
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