Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope
Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope
复制标题
DOI：
10.1503/cmaj.151469
复制
发表时间：
2016-09-06
影响因子：
14.6
通讯作者：
Taljaard, Monica
中科院分区：
文献类型：
--
作者：
Thiruganasambandamoorthy, Venkatesh;Kwong, Kenneth;Taljaard, Monica
背景资料：晕厥可能由初始评估期间不明显的严重状况引起，在急诊科处置后可能导致严重不良事件，包括死亡。我们试图开发一种临床决策工具，以确定成人晕厥患者谁是在一个严重的不良事件后30天内处置从emergency department.Methods的风险：我们前瞻性招募成人（年龄16岁）晕厥谁出现在事件后24小时内，从9月1日至6个大型急诊科之一。2010年2月29日至2014年2月27日。我们从临床评估和调查中收集了指数呈现的标准化变量。裁定的严重不良事件包括死亡，心肌梗死，心律失常，结构性心脏病，肺栓塞，严重出血和手术干预30 days.Results：我们招募了4030例晕厥患者，平均年龄为53.6岁，55.5%是女性，9.5%入院。147例（3.6%）患者在急诊科处置后30天内发生严重不良事件。在检查的43个候选预测因子中，我们在最终模型中纳入了9个：血管迷走性晕厥的易感性、心脏病、急诊科任何收缩压阅读> < 90 or >180 mm Hg、肌钙蛋白水平高于正常人群的第99百分位数、QRS电轴异常（< -30 degrees or >100度）、QRS持续时间长于130 ms、QTc间期长于480 ms、急诊科诊断为心源性晕厥和急诊科诊断为血管迷走性晕厥（C统计量0.88，95%置信区间[CI] 0.85-0.90;乐观0.015;拟合优度p = 0.11）。30天内发生严重不良事件的风险范围为0.4%（评分为-3）至83.6%（评分为11）。敏感性为99.2%（95%CI 95.9%-100%）的阈值评分为-2或更高，97.7%（95%CI 93.5%-99.5%）的阈值评分为-1或更高。解释：加拿大晕厥风险评分显示了良好的区分和校准后，从急诊科处置30天的严重不良事件的风险。一旦得到验证，该工具将能够准确地对晕厥患者的严重不良事件风险进行分层，包括那些可以快速出院的低风险患者。
Background: Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department. We sought to develop a clinical decision tool to identify adult patients with syncope who are at risk of a serious adverse event within 30 days after disposition from the emergency department.Methods: We prospectively enrolled adults (age 16 yr) with syncope who presented within 24 hours after the event to 1 of 6 large emergency departments from Sept. 29, 2010, to Feb. 27, 2014. We collected standardized variables at index presentation from clinical evaluation and investigations. Adjudicated serious adverse events included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, serious hemorrhage and procedural interventions within 30 days.Results: We enrolled 4030 patients with syncope; the mean age was 53.6 years, 55.5% were women, and 9.5% were admitted to hospital. Serious adverse events occurred in 147 (3.6%) of the patients within 30 days after disposition from the emergency department. Of 43 candidate predictors examined, we included 9 in the final model: predisposition to vasovagal syncope, heart disease, any systolic pressure reading in the emergency department < 90 or > 180 mm Hg, troponin level above 99th percentile for the normal population, abnormal QRS axis (< -30 degrees or > 100 degrees), QRS duration longer than 130 ms, QTc interval longer than 480 ms, emergency department diagnosis of cardiac syncope and emergency department diagnosis of vasovagal syncope (C statistic 0.88, 95% confidence interval [CI] 0.85-0.90; optimism 0.015; goodness-of-fit p = 0.11). The risk of a serious adverse event within 30 days ranged from 0.4% for a score of -3 to 83.6% for a score of 11. The sensitivity was 99.2% (95% CI 95.9%-100%) for a threshold score of -2 or higher and 97.7% (95% CI 93.5%-99.5%) for a threshold score of -1 or higher.Interpretation: The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department. Once validated, the tool will be able to accurately stratify the risk of serious adverse events among patients presenting with syncope, including those at low risk who can be discharged home quickly.