6158762938f00ef6495f4fa5892c76af pmc_34833453.pdf 39b834a94ac8b64bc68fceb37be80deb11b68ea7 pmc_34833453.pdf 759bc30de4d631834c409fdbedc275c66a6acd22b7c4e841b7f7917d25d6c8de pmc_34833453.pdf Title: Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis Subject: Background and Objectives: Knowledge of the incidence and time frames of the adverse events of patients presenting syncope at the ED is essential for developing effective management strategies. The aim of the present study was to perform a meta-analysis of the incidence and time frames of adverse events of syncope patients. Materials and Methods: We combined individual patients’ data from prospective observational studies including adult patients who presented syncope at the ED. We assessed the pooled rate of adverse events at 24 h, 72 h, 7–10 days, 1 month and 1 year after ED evaluation. Results: We included nine studies that enrolled 12,269 patients. The mean age varied between 53 and 73 years, with 42% to 57% females. The pooled rate of adverse events was 5.1% (95% CI 3.4% to 7.7%) at 24 h, 7.0% (95% CI 4.9% to 9.9%) at 72 h, 8.4% (95% CI 6.2% to 11.3%) at 7–10 days, 10.3% (95% CI 7.8% to 13.3%) at 1 month and 21.3% (95% CI 15.8% to 28.0%) at 1 year. The pooled death rate was 0.2% (95% CI 0.1% to 0.5%) at 24 h, 0.3% (95% CI 0.1% to 0.7%) at 72 h, 0.5% (95% CI 0.3% to 0.9%) at 7–10 days, 1% (95% CI 0.6% to 1.7%) at 1 month and 5.9% (95% CI 4.5% to 7.7%) at 1 year. The most common adverse event was arrhythmia, for which its rate was 3.1% (95% CI 2.0% to 4.9%) at 24 h, 4.8% (95% CI 3.5% to 6.7%) at 72 h, 5.8% (95% CI 4.2% to 7.9%) at 7–10 days, 6.9% (95% CI 5.3% to 9.1%) at 1 month and 9.9% (95% CI 5.5% to 17) at 1 year. Ventricular arrhythmia was rare. Conclusions: The risk of death or life-threatening adverse event is rare in patients presenting syncope at the ED. The most common adverse events are brady and supraventricular arrhythmias, which occur during the first 3 days. Prolonged ECG monitoring in the ED in a short stay unit with ECG monitoring facilities may, therefore, be beneficial. Keywords: syncope; emergency department; outcomes; adverse events; arrhythmia; mortality; ECG monitoring; individual patient data; meta-analysis Author: Ludovico Furlan, Lucia Trombetta, Giovanni Casazza, Franca Dipaola, Raffaello Furlan, Chiara Marta, Filippo Numeroso, Jordi Pérez-Rodon, James V. Quinn, Matthew J. Reed, Robert S. Sheldon, Win-Kuang Shen, Benjamin C. Sun, Venkatesh Thiruganasambandamoorthy, Andrea Ungar, Giorgio Costantino and Monica Solbiati Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Fri Nov 12 11:19:05 2021 CET ModDate: Fri Nov 12 11:23:26 2021 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 9 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 662263 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- XEFGQJ+VnURWPalladioL Type 1 Custom yes yes no 10 0 KNIXIK+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 UGEAPU+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 WVINRJ+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 BTFGED+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 HVRRJG+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 58 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 62 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 66 0 IKKWKP+CMSY10 Type 1 Builtin yes yes no 78 0 MDKICP+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 103 0 MDKIEA+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 109 0 MDKIFB+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 115 0 MDKIGB+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 121 0 MDKIGC+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 124 0 MDKIGD+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 127 0 MDKICP+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 182 0 MDKIEA+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 188 0 MDKIFB+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 194 0 MDKIGB+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 200 0 MDKIGC+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 203 0 MDKIGD+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 206 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 03:38:05 CEST RepresentationInformation: pmc_34833453.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:06:21 CEST Size: 662263 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 350 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Inclusion Criteria Destination: subsection.2.1 Item: Title: Outcomes and Definitions Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Study Selection and Characteristics Destination: subsection.3.1 Item: Title: Data Synthesis Destination: subsection.3.2 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Syncope Time Frames for Adverse Events after Emergency Department Presentation: An Individual Patient Data Meta-Analysis Author: Ludovico Furlan, Lucia Trombetta, Giovanni Casazza, Franca Dipaola, Raffaello Furlan, Chiara Marta, Filippo Numeroso, Jordi Pérez-Rodon, James V. Quinn, Matthew J. Reed, Robert S. Sheldon, Win-Kuang Shen, Benjamin C. Sun, Venkatesh Thiruganasambandamoorthy, Andrea Ungar, Giorgio Costantino and Monica Solbiati Subject: Background and Objectives: Knowledge of the incidence and time frames of the adverse events of patients presenting syncope at the ED is essential for developing effective management strategies. The aim of the present study was to perform a meta-analysis of the incidence and time frames of adverse events of syncope patients. Materials and Methods: We combined individual patients’ data from prospective observational studies including adult patients who presented syncope at the ED. We assessed the pooled rate of adverse events at 24 h, 72 h, 7 10 days, 1 month and 1 year after ED evaluation. Results: We included nine studies that enrolled 12,269 patients. The mean age varied between 53 and 73 years, with 42% to 57% females. The pooled rate of adverse events was 5.1% (95% CI 3.4% to 7.7%) at 24 h, 7.0% (95% CI 4.9% to 9.9%) at 72 h, 8.4% (95% CI 6.2% to 11.3%) at 7 10 days, 10.3% (95% CI 7.8% to 13.3%) at 1 month and 21.3% (95% CI 15.8% to 28.0%) at 1 year. The pooled death rate was 0.2% (95% CI 0.1% to 0.5%) at 24 h, 0.3% (95% CI 0.1% to 0.7%) at 72 h, 0.5% (95% CI 0.3% to 0.9%) at 7 10 days, 1% (95% CI 0.6% to 1.7%) at 1 month and 5.9% (95% CI 4.5% to 7.7%) at 1 year. The most common adverse event was arrhythmia, for which its rate was 3.1% (95% CI 2.0% to 4.9%) at 24 h, 4.8% (95% CI 3.5% to 6.7%) at 72 h, 5.8% (95% CI 4.2% to 7.9%) at 7 10 days, 6.9% (95% CI 5.3% to 9.1%) at 1 month and 9.9% (95% CI 5.5% to 17) at 1 year. Ventricular arrhythmia was rare. Conclusions: The risk of death or life-threatening adverse event is rare in patients presenting syncope at the ED. The most common adverse events are brady and supraventricular arrhythmias, which occur during the first 3 days. Prolonged ECG monitoring in the ED in a short stay unit with ECG monitoring facilities may, therefore, be beneficial. 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