Does Syncope Predict Mortality in Patients With Acute Pulmonary Embolism? A Retrospective Review
Bibliographic record
Abstract
BACKGROUND: Acute pulmonary embolism (APE) is a potentially fatal disease with high mortality. Prior studies have shown an increased frequency of central localization of the clot, right ventricular dysfunction and elevated troponin in patients who present with syncope and APE. Existing evidence regarding mortality and length of hospital stay in these patients is unclear. METHODS: We retrospectively reviewed electronic medical records of patients who were admitted in a tertiary care hospital in rural Upstate New York and diagnosed with APE from July 2014 to July 2016. Two hundred nineteen patients were reviewed in two groups: patients who presented with syncope and those without syncope. RESULTS: The prevalence of syncope was found to be 6.8% (15/219). Hypotension on admission was more common among patients with syncope compared to no syncope (26.7% and 7.4%, respectively, P = 0.03). A clinically significant difference was found in 30-day mortality among those with syncope versus no syncope (21.3% vs. 7.4%, P = 0.096). No significant difference was found in length of stay (mean 6.7 days in patients with syncope vs. 6.4 without syncope, P = 0.783), central localization (26.7% with syncope vs. 43.2% without syncope, P = 0.21) or troponin elevation (46.2% in patients with syncope vs. 27.9% without syncope, P = 0.205). On multivariable analysis, hypotension was significantly higher among those with syncope (odds ratio: 5.23, P = 0.0148). CONCLUSION: This study suggests 30-day mortality may be higher among patients with syncope. It is important to risk stratify patients on admission in order to reduce mortality and morbidity associated with lethal disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".