Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department: The SyMoNE Multicenter Study

Monica Solbiati, Franca Dipaola, Paolo Villa, Sonia Seghezzi, Ivo Casagranda, Filippo Rabajoli, Elisa Fiorini, Lorenzo Porta, Giovanni Casazza, Antonio Voza, Franca Barbic, Nicola Montano, Raffaello Furlan, Giorgio Costantino

Research output: Contribution to journalArticle

Abstract

Background: Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non–low-risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non–low-risk patients with syncope in the ED. Methods: This prospective multicenter observational study included adult patients presenting to the ED after syncope. Patients without an obvious etiology after ED evaluation who were classified by ED physicians as being at non–low risk of adverse events underwent ECG monitoring. We assessed sensitivity, specificity, and diagnostic yield (defined as the proportion of patients with true-positive ECG monitoring findings) of ECG monitoring in the identification of 7- and 30-day adverse and arrhythmic events according to monitoring duration. Results: Of 242 patients included in the study, 29 patients had 7-day serious outcomes. Ten additional patients had serious outcomes at 30 days. The overall sensitivity, specificity, and diagnostic yield of ECG monitoring in the identification of 7-day adverse events were 0.55 (95% confidence interval [CI] = 0.36 to 0.74], 0.93 (95% CI = 0.89 to 0.96), and 0.07 (95% CI = 0.04 to 0.10), respectively. The sensitivity, specificity, and diagnostic yield of >12-hour ECG monitoring in the identification of 7-day adverse events were 0.89 (95% CI = 0.65 to 0.99), 0.78 (95% CI = 0.67 to 0.87), and 0.18 (95% CI = 0.12 to 0.28), respectively. Similar results were observed for 30-day adverse events. The median (interquartile range) ECG monitoring time was 6.5 (6 to 15) hours. ECG monitoring findings were positive in 31 patients. Conclusions: Although the overall diagnostic accuracy of ECG monitoring is fair, its sensitivity at >12 hours’ duration is substantially higher. These results suggest that prolonged (>12 hours) monitoring is a safe alternative to hospital admission in the management of non–low-risk patients with syncope in the ED.

Original languageEnglish
Pages (from-to)15-23
JournalAcademic Emergency Medicine
Volume27
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

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Syncope
Physiologic Monitoring
Multicenter Studies
Hospital Emergency Service
Confidence Intervals
Risk Management
Sensitivity and Specificity
Observational Studies
Cardiac Arrhythmias
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

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Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department : The SyMoNE Multicenter Study. / Solbiati, Monica; Dipaola, Franca; Villa, Paolo; Seghezzi, Sonia; Casagranda, Ivo; Rabajoli, Filippo; Fiorini, Elisa; Porta, Lorenzo; Casazza, Giovanni; Voza, Antonio; Barbic, Franca; Montano, Nicola; Furlan, Raffaello; Costantino, Giorgio.

In: Academic Emergency Medicine, Vol. 27, No. 1, 01.01.2020, p. 15-23.

Research output: Contribution to journalArticle

Solbiati, Monica ; Dipaola, Franca ; Villa, Paolo ; Seghezzi, Sonia ; Casagranda, Ivo ; Rabajoli, Filippo ; Fiorini, Elisa ; Porta, Lorenzo ; Casazza, Giovanni ; Voza, Antonio ; Barbic, Franca ; Montano, Nicola ; Furlan, Raffaello ; Costantino, Giorgio. / Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department : The SyMoNE Multicenter Study. In: Academic Emergency Medicine. 2020 ; Vol. 27, No. 1. pp. 15-23.
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author = "Monica Solbiati and Franca Dipaola and Paolo Villa and Sonia Seghezzi and Ivo Casagranda and Filippo Rabajoli and Elisa Fiorini and Lorenzo Porta and Giovanni Casazza and Antonio Voza and Franca Barbic and Nicola Montano and Raffaello Furlan and Giorgio Costantino",
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T2 - The SyMoNE Multicenter Study

AU - Solbiati, Monica

AU - Dipaola, Franca

AU - Villa, Paolo

AU - Seghezzi, Sonia

AU - Casagranda, Ivo

AU - Rabajoli, Filippo

AU - Fiorini, Elisa

AU - Porta, Lorenzo

AU - Casazza, Giovanni

AU - Voza, Antonio

AU - Barbic, Franca

AU - Montano, Nicola

AU - Furlan, Raffaello

AU - Costantino, Giorgio

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N2 - Background: Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non–low-risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non–low-risk patients with syncope in the ED. Methods: This prospective multicenter observational study included adult patients presenting to the ED after syncope. Patients without an obvious etiology after ED evaluation who were classified by ED physicians as being at non–low risk of adverse events underwent ECG monitoring. We assessed sensitivity, specificity, and diagnostic yield (defined as the proportion of patients with true-positive ECG monitoring findings) of ECG monitoring in the identification of 7- and 30-day adverse and arrhythmic events according to monitoring duration. Results: Of 242 patients included in the study, 29 patients had 7-day serious outcomes. Ten additional patients had serious outcomes at 30 days. The overall sensitivity, specificity, and diagnostic yield of ECG monitoring in the identification of 7-day adverse events were 0.55 (95% confidence interval [CI] = 0.36 to 0.74], 0.93 (95% CI = 0.89 to 0.96), and 0.07 (95% CI = 0.04 to 0.10), respectively. The sensitivity, specificity, and diagnostic yield of >12-hour ECG monitoring in the identification of 7-day adverse events were 0.89 (95% CI = 0.65 to 0.99), 0.78 (95% CI = 0.67 to 0.87), and 0.18 (95% CI = 0.12 to 0.28), respectively. Similar results were observed for 30-day adverse events. The median (interquartile range) ECG monitoring time was 6.5 (6 to 15) hours. ECG monitoring findings were positive in 31 patients. Conclusions: Although the overall diagnostic accuracy of ECG monitoring is fair, its sensitivity at >12 hours’ duration is substantially higher. These results suggest that prolonged (>12 hours) monitoring is a safe alternative to hospital admission in the management of non–low-risk patients with syncope in the ED.

AB - Background: Arrhythmia is one of the most worrisome causes of syncope. Electrocardiographic (ECG) monitoring is crucial for the management of non–low-risk patients in the emergency department (ED). However, its diagnostic accuracy and optimal duration are unknown. We aimed to assess the diagnostic accuracy of ECG monitoring in non–low-risk patients with syncope in the ED. Methods: This prospective multicenter observational study included adult patients presenting to the ED after syncope. Patients without an obvious etiology after ED evaluation who were classified by ED physicians as being at non–low risk of adverse events underwent ECG monitoring. We assessed sensitivity, specificity, and diagnostic yield (defined as the proportion of patients with true-positive ECG monitoring findings) of ECG monitoring in the identification of 7- and 30-day adverse and arrhythmic events according to monitoring duration. Results: Of 242 patients included in the study, 29 patients had 7-day serious outcomes. Ten additional patients had serious outcomes at 30 days. The overall sensitivity, specificity, and diagnostic yield of ECG monitoring in the identification of 7-day adverse events were 0.55 (95% confidence interval [CI] = 0.36 to 0.74], 0.93 (95% CI = 0.89 to 0.96), and 0.07 (95% CI = 0.04 to 0.10), respectively. The sensitivity, specificity, and diagnostic yield of >12-hour ECG monitoring in the identification of 7-day adverse events were 0.89 (95% CI = 0.65 to 0.99), 0.78 (95% CI = 0.67 to 0.87), and 0.18 (95% CI = 0.12 to 0.28), respectively. Similar results were observed for 30-day adverse events. The median (interquartile range) ECG monitoring time was 6.5 (6 to 15) hours. ECG monitoring findings were positive in 31 patients. Conclusions: Although the overall diagnostic accuracy of ECG monitoring is fair, its sensitivity at >12 hours’ duration is substantially higher. These results suggest that prolonged (>12 hours) monitoring is a safe alternative to hospital admission in the management of non–low-risk patients with syncope in the ED.

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