National trends in resource utilization associated with ED visits for syncope

Area of Science:

• Emergency Medicine
• Cardiology
• Clinical Practice Guidelines

Background:

• Extensive research and guidelines exist to optimize emergency department (ED) resource use for syncope patients.
• Despite these efforts, temporal trends in syncope management remain unclear.

Purpose of the Study:

• To investigate temporal trends in syncope-related ED visits.
• To analyze associated trends in advanced imaging, hospital admissions, and diagnostic frequencies.

Main Methods:

• Analysis of the National Hospital Ambulatory Medical Care Survey ED component (2001-2010).
• Calculation of nationally representative weighted estimates for syncope visits, advanced imaging, and admission rates.
• Tabulation of frequent hospital discharge diagnoses for admitted patients (2005-2010).

Main Results:

• Syncope accounted for approximately 1% of all ED visits (11.9 million nationally).
• Admission rates remained stable (27%-35%), with no significant downward trend.
• Advanced imaging utilization significantly increased from 21% to 45% (P < .001).
• The most common discharge diagnosis for admitted patients was 'syncope and collapse' (36.4%).

Conclusions:

• Resource utilization for ED syncope visits has increased despite optimization efforts.
• No significant improvement in diagnostic yield for admissions was observed.
• Novel strategies are required to alter current practice patterns for syncope management.