Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope
Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope
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DOI：
10.1056/nejmoa1602172
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发表时间：
2016-10-20
影响因子：
158.5
通讯作者：
Barbar, Sofia
中科院分区：
文献类型：
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作者：
Prandoni, Paolo;Lensing, Anthonie W. A.;Barbar, Sofia
背景 因晕厥住院的患者中肺栓塞的患病率尚未得到充分记录，目前的指南很少关注这些患者肺栓塞的诊断检查。 方法 我们对意大利 11 家医院收治的首次晕厥患者进行了系统的肺栓塞检查，无论晕厥是否有其他解释。对于预检临床概率较低的患者，肺栓塞的诊断被排除，该概率根据 Wells 评分结合 D-二聚体检测阴性进行定义。在所有其他患者中，均进行了计算机断层肺血管造影或通气灌注肺扫描。 结果 本研究共纳入 560 名患者（平均年龄 76 岁）。基于肺栓塞预检临床概率较低和 D-二聚体检测阴性的组合，560 名患者中的 330 名患者 (58.9%) 被排除了肺栓塞的诊断。其余 230 名患者中，97 名（42.2%）发现肺栓塞。在整个队列中，肺栓塞的患病率为 17.3%（95% 置信区间，14.2 至 20.5）。在 61 名患者中发现了主肺动脉或肺动脉栓塞的证据，或灌注缺陷大于双肺总面积 25% 的证据。在 355 名对晕厥有其他解释的患者中，有 45 名 (12.7%) 被确诊为肺栓塞，在 205 名没有其他解释的患者中，有 52 名 (25.4%) 被确诊为肺栓塞。结论 因首次晕厥住院的患者中，近六分之一被确诊为肺栓塞。
BACKGROUNDThe prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients.METHODSWe performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative D-dimer assay. In all other patients, computed tomographic pulmonary angiography or ventilation-perfusion lung scanning was performed.RESULTSA total of 560 patients (mean age, 76 years) were included in the study. A diagnosis of pulmonary embolism was ruled out in 330 of the 560 patients (58.9%) on the basis of the combination of a low pretest clinical probability of pulmonary embolism and negative D- dimer assay. Among the remaining 230 patients, pulmonary embolism was identified in 97 (42.2%). In the entire cohort, the prevalence of pulmonary embolism was 17.3% (95% confidence interval, 14.2 to 20.5). Evidence of an embolus in a main pulmonary or lobar artery or evidence of perfusion defects larger than 25% of the total area of both lungs was found in 61 patients. Pulmonary embolism was identified in 45 of the 355 patients (12.7%) who had an alternative explanation for syncope and in 52 of the 205 patients (25.4%) who did not.CONCLUSIONSPulmonary embolism was identified in nearly one of every six patients hospitalized for a first episode of syncope.