A Population-Based Study Evaluating Sex Differences in Patients Presenting to Emergency Departments With Syncope

摘要

OBJECTIVES This study sought to determine whether sex-specific differences in management and outcomes of syncope patients exist. BACKGROUND Syncope is a common presentation to the emergency department (ED) and reason for hospital admission. METHODS Patients ≥18 years of age, presenting to the ED with a primary diagnosis of syncope in Alberta, Canada, from January 1, 2007 to December 12, 2015 were included. ED records were linked to hospital records to identify patients admitted versus discharged from the ED. Outcomes included 30-day and 1-year all-cause mortality. Multivariable mixed-effect logistic regression assessed the association between sex and outcomes. RESULTS Of the 63,274 ED syncope patients, 33,986 (53.7%) were women and 29,288 (46.3%) were men (p < 0.01). Compared with men, women were younger (51.6 ± 23.8 years for women vs. 55.1 ± 20.9 years for men; p < 0.001), less likely to arrive by ambulance (48.4% women vs. 51.7% men; p < 0.001), and had fewer comorbidities (67.9% women vs. 61.8% men with Charlson comorbidity score = 0; p < 0.001). Overall, 12.6% women and 16.8% men were admitted to hospital (p < 0.001). Regardless of discharge status, women had lower mortality rates (30-day admitted: 2.9% women and 4.4% men; p < 0.001; discharged: 0.2% women and 0.4% men; p < 0.001; and 1-year admitted: 12.6% women and 16.1% men; p < 0.001; discharged: 2.4% women and 3.7% men; p < 0.001). After adjusting for confounders, men were associated with 1.4-fold higher odds of death at 1 year. This was unchanged regardless of discharge status. CONCLUSIONS Although women are more likely than men to present to the ED with syncope, they are less likely to be admitted to hospital. Mortality rates are lower for women, regardless of discharge status.