Evaluating an Emergency Department Observation Syncope Protocol for Older Adults

2014-08-27 03:18:21 | BioPortfolio


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.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research




Emergency Department Observation Protocol, Unstructured, inpatient evaluation


University of Southern California
Los Angeles
United States




University of California, Los Angeles

Results (where available)

View Results


Published on BioPortfolio: 2014-08-27T03:18:21-0400

Clinical Trials [1929 Associated Clinical Trials listed on BioPortfolio]

Comparison Between Standard and Ultrasound Integrated Approach for Risk Stratification of Syncope in the Emergency Department

This is a observational prospective study. For patients presenting to the Emergency Department with loss of consciousness, emergency physicians will be asked to screen the real syncope wit...

Ambulatory Post-Syncope Arrhythmia Protection Feasibility Study

The purpose of this study is to conduct an observational investigation of a novel care path used to manage emergency department (ED) presenting syncope patients on an outpatient basis.

Prevalence of PE in ED Patients With Isolated Syncope

Syncope is a rapid onset, transient, loss of consciousness with a short duration. This symptom has been reported to be a specific presentation of patients with pulmonary embolism. However,...

Validation of the San Francisco Syncope Rule

This study was designed to validate the "San Francisco Syncope Rule". This set of rules was derived by Quinn et. al. to help guide the treatment of patients evaluated in the Emergency Dep...

Syncope Decision Aid for Emergency Care

Syncope, or transient loss of consciousness/fainting, is a common emergency department (ED) complaint responsible for over 1 million ED visits yearly. Potential causes include benign condi...

PubMed Articles [12231 Associated PubMed Articles listed on BioPortfolio]

Financial Viability of Emergency Department Observation Unit Billing Models.

Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manne...

Approach to syncope in the emergency department.

Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this ...

Trends in Hospitalization, Readmission, and Diagnostic Testing of Patients Presenting to the Emergency Department With Syncope.

Emergency department (ED) visits for syncope are common and routine diagnostic testing is frequently low yield. Our objective is to determine whether recent guidelines emphasizing limiting hospitaliza...

Syncope: Clinical Study and Outcome of Diagnostic Evaluation.

Syncope is a common clinical presentation in emergency department. The diagnostic workup for syncope causes significant man-hour loss and expensive investigations. Most often the battery of investigat...

Transient loss of consciousness : Algorithm for the (differential) diagnosis of syncope at emergency department.

Transient loss of consciousness (TLoC) is a common complaint leading to presentation at the emergency department. This comprises a heterogeneous group of disorders including cerebral events, metabol...

Medical and Biotech [MESH] Definitions

The specialty or practice of nursing in the care of patients admitted to the emergency department.

Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.

The branch of medicine concerned with the evaluation and initial treatment of urgent and emergent medical problems, such as those caused by accidents, trauma, sudden illness, poisoning, or disasters. Emergency medical care can be provided at the hospital or at sites outside the medical facility.

Research carried out by nurses that uses interviews, data collection, observation, surveys, etc., to evaluate nursing, health, clinical, and nursing education programs and curricula, and which also demonstrates the value of such evaluation.

Services for reporting EMERGENCIES to the police department.

More From BioPortfolio on "Evaluating an Emergency Department Observation Syncope Protocol for Older Adults"

Quick Search


Relevant Topic

Within medicine, nutrition (the study of food and the effect of its components on the body) has many different roles. Appropriate nutrition can help prevent certain diseases, or treat others. In critically ill patients, artificial feeding by tubes need t...

Searches Linking to this Trial