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{
    "pk": 13219,
    "title": "Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism",
    "subtitle": null,
    "abstract": "Introduction:\n Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.\nMethods: \nThis retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).\nResults:\n Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.\nConclusion:\n Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "pulmonary embolism, syncope, risk adjustment"
        }
    ],
    "section": "Critical Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/13j1b5rw",
    "frozenauthors": [
        {
            "first_name": "David",
            "middle_name": "R.",
            "last_name": "Vinson",
            "name_suffix": "",
            "institution": "The Permanente Medical Group, Oakland, California;\nKaiser Permanente Division of Research, Oakland, California;\nKaiser Permanente Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Darcy",
            "middle_name": "C.",
            "last_name": "Engelhart",
            "name_suffix": "",
            "institution": "University of California, San Diego, La Jolla, California",
            "department": "None"
        },
        {
            "first_name": "Disha",
            "middle_name": "",
            "last_name": "Bahl",
            "name_suffix": "",
            "institution": "St. George’s University, School of Medicine, Grenada, West Indies",
            "department": "None"
        },
        {
            "first_name": "Alisha",
            "middle_name": "A.",
            "last_name": "Othieno",
            "name_suffix": "",
            "institution": "University of California, Davis, School of Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Ashley",
            "middle_name": "S.",
            "last_name": "Abraham",
            "name_suffix": "",
            "institution": "University of California, Davis, School of Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Jie",
            "middle_name": "",
            "last_name": "Huang",
            "name_suffix": "",
            "institution": "Kaiser Permanente Division of Research, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "Mary",
            "middle_name": "E.",
            "last_name": "Reed",
            "name_suffix": "",
            "institution": "Kaiser Permanente Division of Research, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "William",
            "middle_name": "P.",
            "last_name": "Swanson",
            "name_suffix": "",
            "institution": "University of California, Davis, School of Medicine, Sacramento, California;\nKaiser Permanente San Diego Medical Center, Department of Emergency Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Victoria",
            "middle_name": "A.",
            "last_name": "Clague",
            "name_suffix": "",
            "institution": "The Permanente Medical Group, Oakland, California;\nKaiser Permanente San Rafael Medical Center, Department of Radiology, San Rafael, California",
            "department": "None"
        },
        {
            "first_name": "Dale",
            "middle_name": "M.",
            "last_name": "Cotton",
            "name_suffix": "",
            "institution": "The Permanente Medical Group, Oakland, California;\nKaiser Permanente South Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "William",
            "middle_name": "C.",
            "last_name": "Krauss",
            "name_suffix": "",
            "institution": "Kaiser Permanente San Diego Medical Center, Department of Emergency Medicine, San Diego, California",
            "department": "None"
        },
        {
            "first_name": "Dustin",
            "middle_name": "G.",
            "last_name": "Mark",
            "name_suffix": "",
            "institution": "The Permanente Medical Group, Oakland, California;\nKaiser Permanente Division of Research, Oakland, California;\nKaiser Permanente Oakland Medical Center, Department of Emergency Medicine, Oakland, California",
            "department": "None"
        }
    ],
    "date_submitted": "2019-08-31T05:18:18+10:00",
    "date_accepted": "2019-08-31T05:18:18+10:00",
    "date_published": "2020-04-14T08:52:45+10:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/13219/galley/6961/download/"
        }
    ]
}