Practical Approaches to Care in Emergency Syncope (PACES)

项目摘要/摘要 该项目的目标是改善急诊科患者的风险分层。 (ED)晕厥(一过性意识丧失)，以便更好地描述患者需要 入院，可以安全地出院回家。晕厥和晕厥前期(即将到来的感觉 意识丧失)是向急诊室提出的常见原因，每年有超过130万人次就诊 在美国。 虽然晕厥通常是良性的，但偶尔也会由严重的心肺疾病引起。 例如心律失常、急性冠脉综合征或肺栓塞。尽管在 在ED中，50%以上的病例晕厥的原因尚不清楚，这导致了大量的 晕厥患者入院接受观察和/或进一步测试。这些入院的人或 观察单元产量低、成本高，并使患者暴露在医源性伤害的可能性中。 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天后严重临床结局的风险。而当 前景看好，这两个风险评分需要在广泛的临床应用之前进行外部验证。在AIM 在这项建议中，我们将前瞻性地收集1600名患有晕厥/晕厥前期的ED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 通过衡量这些评分对医疗保健利用率的潜在影响来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：低风险患者直接出院(30天内严重后果风险低于2%)，以及 中高危患者住院。 如果得到验证并被证明可以安全地减少医疗保健利用率，这些晕厥风险评分可能会发挥重要作用 通过减少低收入入院率和识别符合条件的患者来改善急诊晕厥护理 从急诊室出院不安全。这项题为《佩斯：紧急护理的实用方法》的研究 晕厥，将有助于提高急诊护理的质量和价值，推进晕厥领域 研究。

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.