Syncope accounts for 1%–2% of ED visits. History, physical exam, and ECG establish the etiology of syncope about 50% of the time, but many patients are admitted for observation and telemetry monitoring seeking evidence of arrhythmias. The objectives of this study were to determine (1) the diagnostic yield of telemetry monitoring in unexplained syncope and (2) if the diagnostic yield can be increased by clinical predictors.
We retrospectively assessed 220 consecutive patients older than age 18 who were admitted to a university‐affiliated, public safety‐net hospital with unexplained syncope. Patients with seizure activity or neurologic events, those who were found down or had suffered mechanical falls, and those with near‐syncope were excluded, as were incarcerated patients and those with incomplete records. Patient data were collected from the electronic medical information database. All patients were monitored on telemetry from admission to discharge. Telemetry was considered positive if it revealed ventricular fibrillation, ventricular tachycardia, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, atrioventricular block, sinus pause, or symptomatic brady‐cardia that resulted in a clinical intervention. Potential clinical predictors were determined by using ICD‐9 codes of discharge diagnoses. Ejection fraction (EF) was determined from reviewing echocardiograms for all patients with an ICD‐9 code for congestive heart failure.
Only 8 of 220 patients had clinically significant arrhythmias detected on telemetry monitoring (diagnostic yield, 3.6%). These included atrial tachyarrhythmias (n = 3), ventricular tachy‐arrhythmias (n = 3), and bradyarrhythmias (n = 2). Multi‐variate analysis determined that age (OR, 2.3; P < 0.003) and EF < 35% (OR, 21.9; P < 0.005) predicted telemetry events. The presence of either of these predictors increased the diagnostic yield to 10.8%. All 8 patients with arrhythmias detected by telemetry monitoring were older than 64 years, and 3 had an EF < 35% (Table 1). The presence of coronary disease, diabetes mellitus, and hypertension were not significant predictors. Prior arrhythmia and valvular disease occurred too infrequently to evaluate. Two patients had life‐threatening arrhythmias that resulted in death, and both had an EF < 35% and were older than 64 years.
The yield of telemetry monitoring in unexplained syncope was low but could be markedly increased by using simple clinical predictors.
M. Maher ‐ none; R. Albert ‐ none; A. Keniston ‐ none
To cite this abstract:Maher M, Albert R, Keniston A. Use of Clinical Predictors Increase the Yield of Telemetry Monitoring in Unexplained Syncope. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 74. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/use-of-clinical-predictors-increase-the-yield-of-telemetry-monitoring-in-unexplained-syncope/. Accessed April 1, 2020.