Prevalence of pulmonary embolism in patients with syncope

Giorgio Costantino, Martin H. Ruwald, James Quinn, Carlos A. Camargo, Frederik Dalgaard, Gunnar Gislason, Tadahiro Goto, Kohei Hasegawa, Padma Kaul, Nicola Montano, Anna Karin Numé, Antonio Russo, Robert Sheldon, Monica Solbiati, Benjamin Sun, Giovanni Casazza

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

IMPORTANCE Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope. OBJECTIVE To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope. DESIGN, SETTING, AND PARTICIPANTS This retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged 18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016. MAIN OUTCOMES AND MEASURES The prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed. RESULTS A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients. CONCLUSIONS AND RELEVANCE Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.

Original languageEnglish
Pages (from-to)356-362
Number of pages7
JournalJAMA Internal Medicine
Volume178
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Syncope
Pulmonary Embolism
Hospital Emergency Service
Venous Thromboembolism
International Classification of Diseases
Denmark
Italy
Canada
Observational Studies
Retrospective Studies
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Costantino, G., Ruwald, M. H., Quinn, J., Camargo, C. A., Dalgaard, F., Gislason, G., ... Casazza, G. (2018). Prevalence of pulmonary embolism in patients with syncope. JAMA Internal Medicine, 178(3), 356-362. https://doi.org/10.1001/jamainternmed.2017.8175

Prevalence of pulmonary embolism in patients with syncope. / Costantino, Giorgio; Ruwald, Martin H.; Quinn, James; Camargo, Carlos A.; Dalgaard, Frederik; Gislason, Gunnar; Goto, Tadahiro; Hasegawa, Kohei; Kaul, Padma; Montano, Nicola; Numé, Anna Karin; Russo, Antonio; Sheldon, Robert; Solbiati, Monica; Sun, Benjamin; Casazza, Giovanni.

In: JAMA Internal Medicine, Vol. 178, No. 3, 01.03.2018, p. 356-362.

Research output: Contribution to journalArticle

Costantino, G, Ruwald, MH, Quinn, J, Camargo, CA, Dalgaard, F, Gislason, G, Goto, T, Hasegawa, K, Kaul, P, Montano, N, Numé, AK, Russo, A, Sheldon, R, Solbiati, M, Sun, B & Casazza, G 2018, 'Prevalence of pulmonary embolism in patients with syncope', JAMA Internal Medicine, vol. 178, no. 3, pp. 356-362. https://doi.org/10.1001/jamainternmed.2017.8175
Costantino G, Ruwald MH, Quinn J, Camargo CA, Dalgaard F, Gislason G et al. Prevalence of pulmonary embolism in patients with syncope. JAMA Internal Medicine. 2018 Mar 1;178(3):356-362. https://doi.org/10.1001/jamainternmed.2017.8175
Costantino, Giorgio ; Ruwald, Martin H. ; Quinn, James ; Camargo, Carlos A. ; Dalgaard, Frederik ; Gislason, Gunnar ; Goto, Tadahiro ; Hasegawa, Kohei ; Kaul, Padma ; Montano, Nicola ; Numé, Anna Karin ; Russo, Antonio ; Sheldon, Robert ; Solbiati, Monica ; Sun, Benjamin ; Casazza, Giovanni. / Prevalence of pulmonary embolism in patients with syncope. In: JAMA Internal Medicine. 2018 ; Vol. 178, No. 3. pp. 356-362.
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abstract = "IMPORTANCE Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope. OBJECTIVE To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope. DESIGN, SETTING, AND PARTICIPANTS This retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged 18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016. MAIN OUTCOMES AND MEASURES The prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed. RESULTS A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06{\%} (95{\%} CI, 0.05{\%}-0.06{\%}) to 0.55{\%} (95{\%} CI, 0.50{\%}-0.61{\%}) for all patients and from 0.15{\%} (95{\%} CI, 0.14{\%}-0.16{\%}) to 2.10{\%} (95{\%} CI, 1.84{\%}-2.39{\%}) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14{\%} (95{\%} CI, 0.13{\%}-0.14{\%}) to 0.83{\%} (95{\%} CI, 0.80{\%}-0.86{\%}) for all patients and from 0.35{\%} (95{\%} CI, 0.34{\%}-0.37{\%}) to 2.63{\%} (95{\%} CI, 2.34{\%}-2.95{\%}) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30{\%} (95{\%} CI, 0.29{\%}-0.31{\%}) to 1.37{\%} (95{\%} CI, 1.33{\%}-1.41{\%}) for all patients and from 0.75{\%} (95{\%} CI, 0.73{\%}-0.78{\%}) to 3.86{\%} (95{\%} CI, 3.51{\%}-4.24{\%}) for hospitalized patients. CONCLUSIONS AND RELEVANCE Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.",
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T1 - Prevalence of pulmonary embolism in patients with syncope

AU - Costantino, Giorgio

AU - Ruwald, Martin H.

AU - Quinn, James

AU - Camargo, Carlos A.

AU - Dalgaard, Frederik

AU - Gislason, Gunnar

AU - Goto, Tadahiro

AU - Hasegawa, Kohei

AU - Kaul, Padma

AU - Montano, Nicola

AU - Numé, Anna Karin

AU - Russo, Antonio

AU - Sheldon, Robert

AU - Solbiati, Monica

AU - Sun, Benjamin

AU - Casazza, Giovanni

PY - 2018/3/1

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N2 - IMPORTANCE Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope. OBJECTIVE To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope. DESIGN, SETTING, AND PARTICIPANTS This retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged 18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016. MAIN OUTCOMES AND MEASURES The prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed. RESULTS A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients. CONCLUSIONS AND RELEVANCE Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.

AB - IMPORTANCE Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope. OBJECTIVE To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope. DESIGN, SETTING, AND PARTICIPANTS This retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged 18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016. MAIN OUTCOMES AND MEASURES The prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed. RESULTS A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients. CONCLUSIONS AND RELEVANCE Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.

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