The Journal of the American College of Cardiology presented the ROSE study for triaging patients with syncope in the emergency department. No, ROSE isn’t some LOL that the study was named after. ROSE is an acronym standing for “Risk Stratification of Syncope in the Emergency Department.” They just left out a few letters because an acronym of “RSOSITED” just isn’t quite as catchy. Maybe SOS-ED would have been cooler, but ROSE it is.
Anyway, the study looked at what factors were likely to be present in patients who passed out and who had a “serious outcome” or death in the following month. Serious outcomes or death occurred in 7% of all patients who passed out in this study. They found that positive fecal occult blood, low hemoglobin levels, low oxygen saturation, and Q waves on the EKG were all predictive of worse prognosis for patients with syncope.
In addition, a BNP (brain natriuretic peptide) level greater than 300 was present in 36% of syncopal patients who later suffered serious cardiovascular events and in 89% of syncopal patients who later died.
More than 98% of patients who had none of these risk factors also had no serious outcome or death in the subsequent month after their syncopal event.
So check the BNP on syncope patients and get out those rubber gloves, ladies and gents. Add syncope to the list of patient complaints for which rectal exams may be indicated.
After all this, if you’re still wondering what “LOL who DFO” means, then you have to read this religious post.
right. and then they can spin this to create a list of findings without which medicare will not pay for an admission for syncope.
of course if all signs are absent, the patient is sent home and then dies of an arrythmia, who is blamed?
Err…. I’m a little slow tonight. DFO?
Is syncope a reason to go to the hospital? I’ve fainted about 4 times in my life (I’m 30)…and I never once thought you should go the the ER. Heck, I don’t think I’ve ever mentioned it to a doctor.
I’m not asking for medical advice, I guess I just never thought people went to the ER for just fainting. I could understand if it was associated with some other complaint, like chest pain or headache etc.
These numbers won’t help with our defense when sued by a relative after Granny gets sent home from the ED and has a bad outcome.
“If you’d admitted her and done more testing she’d be alive today, now wouldn’t she, Doctor! Well, we’ll never know since you didn’t give her that chance.”
-Steve
i for one am not willing to diagnose the elderly with vasovagal syncope. if the admission gets retrospectively denied because the inpatient workup turns out to be negative (a very common occurrence), we can either fight to get it covered, go after the patient for payment, or just ratchet up the prices of other services that we are able to collect on. and continue our financial tailspin into oblivion.
thankfully, there is no such thing as defensive medicine (or so i’m told).. can you imagine how much more expensive all this would be if such a concept existed? hoo boy!
DFO=Done Fell out
RBS= Real bad sick.
Common sayings around these parts.
Interesting.
From the article there is a mnemonic: BRACES
The ROSE rule Admit if any of the following are present:
B B NP level ≥ 300pg/ml B radycardia ≤50 in Emergency Department or pre-hospital
R R ectal examination showing fecal occult blood (if suspicion of gastrointestinal bleed)
A A nemia – Hemoglobin ≤90 g/l
C C hest pain associated with syncope
E E CG showing Q wave (not in lead III)
S S aturation ≤94% on room air
I’d like to know if emergency doctors discuss [seriously] about the great expense and financial burden old people bring to the system. I’m aware this is a highly controversial topic, but it’s clear that we’re heading for a collapse [it's said that denial is thick as a brick, you can cut it with a knife]. It’s my belief that the most educated people in the Planet [M.D.s, Ph.D.s]should be able to articulate some avenues for overcoming this predicament. If prolonging life at all costs is what everybody is thinking in a knee-jerk reaction way, then forget it, we’re not ready and doom may come. Please post serious stuff, please share links and references with DATA or with insightful comments. I’m not interested in emotional outbursts (keep those to yourself). You might not be ready for this discussion, I can understand it.
I approve this message.
Why not withhold medical intervention from ALL people who have accidents or serious illness. No more by-pass operations, no more cancer treatments, heck…while we’re at it, think of all the money we could save by not vaccinating people!
We can very quickly reduce the surplus population.
Your post about church syncope was very funny.
Nice to see you didn’t have to hold up in your basement for long.
BNP is ‘Brain’ Naturietic Peptide? My lab says Beta-type Natriuretic Peptide. Nothing much to do with the brain. Picky, I know…
i think the substance was first isolated from pig brains. i have also seen “beta” used interchangeably but not sure where the beta comes from.