Diagnostic Yield of Hospitalization for Emergency Department Patients With Syncope and Presyncope.

OBJECTIVES: Syncope and presyncope are common emergency department (ED) presentations that may indicate dangerous underlying conditions. For patients without serious ED diagnoses, hospitalization for monitoring and further workup is common, yet the benefits remain unclear. We sought to determine the diagnostic yield of hospitalization among adults with unexplained syncope or presyncope. METHODS: We conducted a secondary analysis of data from a prospective, multicenter, observational study enrolling ED patients aged ≥ 40 years with syncope or presyncope and no serious ED diagnosis. We collected 30-day serious adverse outcomes (SAOs), both cardiac and non-cardiac, including only in-hospital SAOs for admitted patients and all SAOs for discharged patients. Logistic and Cox regression analyses compared admitted and discharged participants using propensity score adjustment and matching. RESULTS: Among 1263 patients (mean age 64.8 ± 13.1 years), 74 (5.9%) experienced any SAO, including 62 (4.9%) with serious cardiac outcomes. After propensity-score adjustment, Bayesian logistic regression showed a significant difference in diagnostic yield (OR 3.70 [95% CrI 1.85-6.82]) in the hospitalized cohort. In a propensity-score-matched Cox regression analysis, hospitalization was associated with a shorter time to SAO diagnosis, with an HR of 12.43 (95% CI 2.94-52.48). CONCLUSION: Hospitalization increased the diagnostic yield for SAOs and accelerated time to diagnosis. It is reasonable to hospitalize select, higher-risk adult patients over 40 years old with presyncope or syncope, even if no dangerous diagnosis is found in the ED. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04533425.