Risk of Vascular Events in Emergency Department Patients Discharged Home With Diagnosis of Dizziness or Vertigo
Risk of Vascular Events in Emergency Department Patients Discharged Home With Diagnosis of Dizziness or Vertigo
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DOI：
10.1016/j.annemergmed.2010.06.559
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发表时间：
2011-01-01
影响因子：
6.2
通讯作者：
Johnston, S. Claiborne
中科院分区：
文献类型：
--
作者：
Kim, Anthony S.;Fullerton, Heather J.;Johnston, S. Claiborne
试验目的：头晕和眩晕是急诊科（艾德）就诊的常见原因，但许多患者在没有具体诊断的情况下出院回家。考虑到重要的诊断可能会被错过，我们衡量的发病率，随后的主要血管事件的患者出院后home.Methods：我们确定了所有成年人出院回家从加州急诊室与头晕或眩晕的主要诊断，从2005年1月至6月，使用全面的遭遇记录。事件与全州出院和全国死亡率数据相关。我们使用Nelson-Aalen生存分析作为主要结局，脑血管病住院或死亡（急性缺血性或出血性卒中）或心血管事件（急性心肌梗死、不稳定型心绞痛和室性心律失常），以及次要结局，因头晕或眩晕、脑血管事件和心血管事件而重复艾德就诊。结果：在确定的31，159例患者中，中位年龄为56岁，63.5%为女性。在随访期间，有274例死亡，231例脑血管事件和115例心血管事件。血管事件、脑血管事件或心血管事件的180天累积发生率分别为0.93%（95%置信区间[CI] 0.83%-1.04%）、0.63%（95% CI 0.55%-0.72%）和0.32%（0.26%-0.38%）。脑血管事件的危险性在第一个月较高（95% CI 30.2 [24.4 - 37.0] vs 6.5 [5.3 - 7.9]起事件/10，000人-月）。结论：很少有患者在出院回家后发生重大血管事件，诊断为头晕或眩晕，在第一个月内，500名患者中中风的发生率小于1。未来的研究需要准确地对个体患者的风险进行分层。[Ann 2011;57：34-41.]
Study objective: Dizziness and vertigo are common reasons for visiting the emergency department (ED), but many patients are discharged home without a specific diagnosis. Given the concern that important diagnoses could be missed, we measure the incidence of subsequent major vascular events in patients after discharge home.Methods: We identified all adults discharged home from California EDs with a primary diagnosis of dizziness or vertigo from January to June 2005, using comprehensive encounter records. Events were captured with linked statewide hospital discharge and national mortality data. We used Nelson-Aalen survival analysis for the primary outcome, hospitalization or death for cerebrovascular (acute ischemic or hemorrhagic stroke) or cardiovascular events (acute myocardial infarction, unstable angina, and ventricular arrhythmia), and the secondary outcomes, repeat ED visit for dizziness or vertigo, cerebrovascular events, and cardiovascular events.Results: Among 31,159 patients identified, median age was 56 years and 63.5% were women. During the follow-up period, there were 274 deaths, 231 cerebrovascular events, and 115 cardiovascular events. The 180-day cumulative incidence of vascular event, cerebrovascular event, or cardiovascular event was 0.93% (95% confidence interval [Cl] 0.83% to 1.04%), 0.63% (95% Cl 0.55% to 0.72%), and 0.32% (0.26% to 0.38%), respectively. The risk of cerebrovascular events was higher in the first month (95% Cl 30.2 [24.4 to 37.0] versus 6.5 [5.3 to 7.9] events/10,000 person-months thereafter).Conclusion: Few patients experience a major vascular event after discharge home with a diagnosis of dizziness or vertigo, with a stroke occurring in less than 1 in 500 patients within the first month. Future studies will be required to accurately stratify the risk for individual patients. [Ann Emerg Med. 2011;57:34-41.]