Relation of clinical presentation of syncope to the age of patients
Relation of clinical presentation of syncope to the age of patients
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DOI：
10.1016/j.amjcard.2005.07.047
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发表时间：
2005-11-15
影响因子：
2.8
通讯作者：
Raviele, A
中科院分区：
文献类型：
--
作者：
Del Rosso, A;Alboni, P;Raviele, A
该研究的目的是评估患者年龄对晕厥临床表现的影响，并确定老年患者临床病史的诊断价值。总共 485 名连续转诊至二级和三级医院的不明原因晕厥患者被分为 2 个预定年龄组：224 名患者 < 65 岁，261 名患者>= 65 岁。晕厥原因的诊断标准是在研究开始之前制定的。使用标准的 46 项表格分析晕厥的临床特征。 27 名年轻患者 (12%) 和 89 名老年患者 (34%) 被确定为心脏病原因。在 154 名年轻患者 (68%) 和 142 名老年患者 (54%) 中确定了神经介导的病因。在2:65岁的患者中，心脏性晕厥和神经介导性晕厥的临床特征非常相似。 26% 的年轻患者和 5% 的老年患者仅根据病史即可诊断晕厥原因 (p < 0.0001)。肌阵挛运动、用力性晕厥和意识丧失期间的仰卧位是老年患者心脏病原因晕厥的最具体的诊断标准（分别为 97%、99% 和 99%），但它们总共只占患者的 14%。总之，与年轻患者相比，病史对于老年患者晕厥原因的诊断价值有限。某些特征的特异性很高，但仅在少数患者中观察到。 (c) 2005 Elsevier Inc. 保留所有权利。
The aim of the study was to evaluate the effect of patient age on the clinical presentation of syncope and to establish the diagnostic value of clinical history in older patients. A total of 485 consecutive patients with unexplained syncope referred to secondary and tertiary hospitals were divided into 2 predefined age groups: 224 patients < 65 years and 261 patients;>= 65 years. The diagnostic criteria for the cause of syncope were developed before the beginning of the study. The clinical features of syncope were analyzed using a standard 46-item form. A cardiac cause of syncope was established in 27 younger (12%) and 89 older (34%) patients. A neurally mediated cause was established in 154 younger (68%) and 142 older (54%) patients. In patients :2:65 years, the clinical features of cardiac and neurally mediated syncope were very similar. The diagnosis of the cause of syncope was possible on the basis of the history alone in 26% younger and 5% older patients (p < 0.0001). Myoclonic movements, effort syncope, and supine position during loss of consciousness were the most specific (97%, 99%, and 99%, respectively) diagnostic criteria for a cardiac cause of syncope in older patients, but, all together, they accounted for only 14% of patients. In conclusion, compared with younger patients, the medical history has a limited value in the diagnosis of the cause of syncope in older patients. The specificity of some features is high but these can be observed in only a minority of patients. (c) 2005 Elsevier Inc. All rights reserved.