Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
J Am Coll Cardiol. 2010 Feb 23;55(8):713-21. doi: 10.1016/j.jacc.2009.09.049.
The aim of this study was to develop and validate a clinical decision rule (CDR) to predict 1-month serious outcome and all-cause death in patients presenting with syncope to the emergency department.
Syncope is a common, potentially serious condition accounting for many hospital admissions.
This was a single center, prospective, observational study of adults presenting to the emergency department with syncope. A CDR was devised from 550 patients in a derivation cohort and tested in a validation cohort of a further 550 patients.
One-month serious outcome or all-cause death occurred in 40 (7.3%) patients in the derivation cohort. Independent predictors were brain natriuretic peptide concentration > or =300 pg/ml (odds ratio [OR]: 7.3), positive fecal occult blood (OR: 13.2), hemoglobin < or =90 g/l (OR: 6.7), oxygen saturation < or =94% (OR: 3.0), and Q-wave on the presenting electrocardiogram (OR: 2.8). One-month serious outcome or all-cause death occurred in 39 (7.1%) patients in the validation cohort. The ROSE (Risk stratification Of Syncope in the Emergency department) rule had a sensitivity and specificity of 87.2% and 65.5%, respectively, and a negative predictive value of 98.5%. An elevated B-type natriuretic peptide (BNP) concentration alone was a major predictor of serious cardiovascular outcomes (8 of 22 events, 36%) and all-cause deaths (8 of 9 deaths, 89%).
The ROSE rule has excellent sensitivity and negative predictive value in the identification of high-risk patients with syncope. As a component, BNP seems to be a major predictor of serious cardiovascular outcomes and all-cause death. The ROSE rule and BNP measurement might be valuable risk stratification tools in patients with emergency presentations of syncope and should now be subjected to external validation.
本研究旨在制定并验证一种临床决策规则（CDR），以预测因晕厥就诊于急诊科的患者 1 个月内的严重结局和全因死亡。
晕厥是一种常见的潜在严重疾病，可导致许多患者住院。
这是一项单中心、前瞻性、观察性研究，纳入了因晕厥就诊于急诊科的成年患者。从 550 例患者的推导队列中制定了 CDR，并在进一步的 550 例患者的验证队列中进行了测试。
推导队列中，40 例（7.3%）患者在 1 个月内出现严重结局或全因死亡。独立预测因素为脑钠肽浓度> =300 pg/ml（优势比[OR]：7.3）、粪便潜血阳性（OR：13.2）、血红蛋白< =90 g/l（OR：6.7）、氧饱和度< =94%（OR：3.0）和入院时心电图 Q 波（OR：2.8）。验证队列中，有 39 例（7.1%）患者在 1 个月内出现严重结局或全因死亡。ROSE（急诊科晕厥风险分层）规则的敏感性和特异性分别为 87.2%和 65.5%，阴性预测值为 98.5%。单独升高的 B 型利钠肽（BNP）浓度是严重心血管结局（8 例事件，36%）和全因死亡（9 例死亡，89%）的主要预测因素。
ROSE 规则在识别高危晕厥患者方面具有较高的敏感性和阴性预测值。作为一个组成部分，BNP 似乎是严重心血管结局和全因死亡的主要预测因素。ROSE 规则和 BNP 测量可能是急诊晕厥患者有价值的风险分层工具，现在应进行外部验证。
