Syncope Risk Stratification in the Emergency Department: Another Step Forward.
Syncope Risk Stratification in the Emergency Department: Another Step Forward.
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DOI：
10.1111/acem.13036
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
Hiestand BC
中科院分区：
文献类型：
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作者：
Nicks BA;Hiestand BC
晕厥被定义为一种由全脑灌注不足引起的短暂性意识丧失，是急诊科（ED）常见而复杂的主诉。尽管占所有ED病例的不到2%，但仅在美国，大约40%的此类患者随后入院，花费超过24亿美元。2,3,4目前，没有证据表明目前的入院模式能改善长期生活质量或生存能力，这进一步加剧了人们对低诊断和治疗效益的经济成本的担忧。1,4 - 7在晕厥患者的急诊管理中，临床决策具有挑战性。通常，在最初的ED评估中无法确定明确的诊断。由于在心源性晕厥风险增加的患者中，晕厥可能是猝死的潜在先兆，因此接受高危和中危患者仍然是常见的做法。1,2 - 6这也可能导致患者住院的风险超过“无风险”。虽然这种零遗漏方法的基本原理在概念上很吸引人，但院内评估改善患者临床结果的假设从未得到验证。
Syncope, defined as a transient loss of consciousness attributable to global cerebral hypoperfusion, remains a common and complex chief complaint in emergency departments (ED). 1 Although accounting for< 2% of all ED presentations, roughly 40% of such patients are subsequently admitted costing more than $2.4 billion in the US alone. 2, 3, 4 Currently, there is no evidence that current admission patterns improve long-term quality-of-life or survivability, furthering the concern over economic cost with low diagnostic and therapeutic benefit. 1, 4–7Clinical decision making can be challenging in the ED management of patients with syncope. 1 Often, a definitive diagnosis cannot be determined during the initial ED evaluation. Because syncope may potentially be a harbinger of sudden death among patients with increased risk of cardiac syncope, admission of the high-and intermediate-risk patients remains common practice. 1, 2–6 This can also result in patients with any more than ‘no-risk’being hospitalized. Although the rationale of this zero-miss approach can conceptually be appealing, the presumption that in-hospital evaluation improves a patient’s clinical outcome has never been validated.