Standardized Approaches to the Investigation of Syncope: Canadian Cardiovascular Society Position Paper
Standardized Approaches to the Investigation of Syncope: Canadian Cardiovascular Society Position Paper
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DOI：
10.1016/j.cjca.2010.11.002
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发表时间：
2011-03-01
影响因子：
6.2
通讯作者：
Leather, Richard
中科院分区：
文献类型：
--
作者：
Sheldon, Robert S.;Morillo, Carlas A.;Leather, Richard
晕厥在急诊科是一种非常常见的表现，广泛的鉴别诊断、一系列的预后和罕见的晕厥记录相结合，导致患者入院的比例很高。这些问题反映在对晕厥住院患者的调查中，对于晕厥来说，良性结果的患者比例很高，而且医护人员对风险的厌恶程度很高，这使得评估成本高昂且效率低下。通过标准化方法，如指南、路径和清单，可以改善提供卫生服务方面的这类困难。因此，急诊科决策规则、专门的晕厥监测单元和正式的诊断算法已经开发出来，为晕厥的调查提供标准化的方法。为了对晕厥的管理提供指导，加拿大心血管学会委托撰写了一份关于成人晕厥调查的标准化方法的立场文件。一个初级小组首先系统地审查文献，然后对数据进行迭代合成，最后根据年级框架提出具体建议。本文总结了证据及其质量，并就值得采用的具体方法提出了建议。立场文件随后由一个二级小组审查，该小组就最后文件提出修订建议，见下文。总体而言，立场小组的结论是，几乎没有令人信服的证据表明，急诊科晕厥规则和诊断晕厥单元提供了有效的护理和改善的结果，但有专家支持的正式诊断算法显示出希望。
Syncope is a very common presentation in the emergency department, and the combination of a wide differential diagnosis, a range of prognoses, and infrequent documentation of the faint leads to a high proportion of patients being admitted. These problems are mirrored in the investigation of inpatients with syncope, for which the high proportion of patients with benign outcomes and the profound risk aversion of health care providers make for expensive and inefficient assessment. Difficulties such as this in health services delivery can be improved by standardized approaches, such as guidelines, pathways, and checklists. Accordingly, emergency department decision rules, specialized syncope-monitoring units, and formal diagnostic algorithms have been developed to provide standardized approaches to the investigation of syncope. To provide guidance in the management of syncope, the Canadian Cardiovascular Society commissioned a position paper on standardized approaches to syncope investigation in adults. A primary panel first reviewed the literature systematically, then undertook iterative syntheses of data, and finally took positions with specific recommendations according to the GRADE framework. This paper summarizes the evidence and its quality and makes recommendations on the specific approaches meriting adoption. The position paper was then reviewed by a secondary panel, which provided suggestions for revisions leading to the final document as presented here. Overall, the position group concluded that there is little persuasive evidence that emergency department syncope rules and diagnostic syncope units provide efficient care and improved outcomes but that formal diagnostic algorithms with specialist support show promise.