Practical Approaches to Care in Emergency Syncope (PACES)

紧急晕厥的实用护理方法 (PACES)

• 批准号: 10445071
• 负责人: Marc Probst
• 金额: $ 79.78万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10445071
• 关键词: Accident and Emergency department; Admission activity; Adult; Age; Algorithms; Arrhythmia; Benign; Cardiac; Caring; Clinical; Clinical Data; Clinical Management; Data; Derivation procedure; Emergency Care; Emergency Department patient; Emergency Situation; Emergency department visit; Enrollment; Esthesia; Evaluation; Funding; Goals; Health Care Costs; Health system; Home; Hospitalization; Hospitals; Iatrogenesis; Intervention; Judgment; Knowledge; Laboratories; Measures; Medical; Methodology; Minority; Myocardial Infarction; Names; National Heart, Lung, and Blood Institute; Observational Study; Outcome; Patients; Performance; Physicians; Play; Population; Publishing; Pulmonary Embolism; Pulmonary Heart Disease; Quality of Care; Research; Research Assistant; Research Personnel; Research Training; Resources; Risk; Role; Sensitivity and Specificity; Site; Syncope; Testing; Unconscious State; United States; Validation; Visit; acute coronary syndrome; base; clinical care; clinical implementation; clinical practice; cost; experience; health care service utilization; health record; health service use; high risk; improved; novel; patient population; patient safety; patient stratification; prospective; response; risk stratification; tool

Project Summary/Abstract The goal of this project is to improve risk-stratification for patients who present to the emergency department (ED) with syncope (transient loss of consciousness), in order to better delineate which patients require admission and which can be safely discharged home. Syncope and pre-syncope (the sensation of impending loss of consciousness) are common reasons to present to the ED, representing over 1.3 million visits per year in the United States. Although syncope is most often benign, it can occasionally be caused by serious cardiopulmonary diseases such as cardiac arrhythmia, acute coronary syndrome, or pulmonary embolism. Despite thorough evaluation in the ED, the cause of syncope remains unknown in over 50% of cases, which leads to a large number of syncope patients being admitted for observation and/or further testing. These admissions to the hospital or observation unit are low-yield, costly, and expose patients to the possibility of iatrogenic harm. In response to this, two groups of researchers have developed distinct syncope risk-stratification tools: the US Syncope Risk Score and the Canadian Syncope Risk Score. These scores use a combination of clinical, electrocardiographic, and laboratory variables to predict the risk of serious clinical outcomes at 30 days. While promising, these two risk scores require external validation prior to widespread clinical implementation. In Aim 1 of this proposal, we will prospectively collect clinical data on 1,600 ED patients with syncope/pre-syncope and follow them for 30 days to validate the predictive accuracy of these two risk scores. In Aim 2, we will assess the impact of implementing these scores by measuring their potential effect on healthcare utilization and costs. Existing care will be used as the reference strategy and will be compared with a simple risk-based clinical algorithm: Direct discharge for low risk patients (under 2% risk of serious outcome at 30 days), and hospitalization for medium- and high-risk patients. If validated and shown to safely reduce healthcare utilization, these syncope risk scores could play a major role in improving emergency syncope care by reducing low-yield admissions and identifying patients who are unsafe for discharge from the ED. This study, entitled PACES: Practical Approaches to Care in Emergency Syncope, will help increase the quality and value of emergency care, and advance the field of syncope research.

项目总结/摘要 该项目的目标是改善急诊科患者的风险分层 (ED)晕厥（短暂性意识丧失），以便更好地描述哪些患者需要 可以安全出院回家。晕厥和晕厥前期（即将发生的感觉 意识丧失）是向艾德就诊的常见原因，每年就诊超过130万人次 在美国 虽然晕厥通常是良性的，但偶尔也可能由严重的心肺疾病引起 例如心律失常、急性冠状动脉综合征或肺栓塞。尽管进行了全面评估， 在艾德中，超过50%的病例中晕厥的原因仍然未知，这导致了大量的 晕厥患者入院接受观察和/或进一步检查。这些入院或 观察单元产量低、成本高，并可能使患者受到医源性伤害。 针对这一点，两组研究人员开发了不同的晕厥风险分层工具：美国 晕厥风险评分和加拿大晕厥风险评分。这些评分结合了临床， 心电图和实验室变量来预测30天时严重临床结局的风险。而 这两个风险评分很有希望，在广泛的临床实施之前需要外部验证。在Aim中 根据本提案的第1条，我们将前瞻性收集1，600例艾德晕厥/晕厥前期患者的临床数据 并跟踪他们30天，以验证这两个风险评分的预测准确性。在目标2中，我们将 通过测量这些评分对医疗保健利用的潜在影响，评估实施这些评分的影响 和成本。现有的护理将被用作参考策略，并将与简单的基于风险的 临床算法：低风险患者（30天时严重结局风险低于2%）直接出院，以及 中、高危患者住院治疗。 如果经过验证并证明可以安全地减少医疗保健利用，这些晕厥风险评分可能会发挥重要作用 通过减少低收益入院和识别符合以下条件的患者来改善紧急晕厥护理 这项研究，题为PACES：实用的方法来照顾紧急情况下， 晕厥，将有助于提高急诊护理的质量和价值，推进晕厥领域的研究 research.