Friedrich-Alexander-Universität Erlangen-Nürnberg.
Dtsch Arztebl Int. 2012 Jan;109(4):58-65. doi: 10.3238/arztebl.2012.0058. Epub 2012 Jan 27.
We studied the characteristics and resource utilization of patients with syncope in a German emergency department (ED).
We carried out a single-center retrospective analysis of patients with syncope who presented to the ED of the Klinikum Nürnberg (a municipal hospital in Nuremberg, Germany).
Among the 28 477 patients who presented to the ED from 15 May 2009 to 30 September 2009, 440 (1.5%) presented with syncope. Their mean age was 62 years (standard deviation, 20 years); 50.4% were women, 43.4% were over age 70, 11.8% had cardiogenic and 4.8% neurological syncope, and 18.2% had more than two comorbid conditions. 20.7% were discharged after evaluation in the ED, 14.1% were brielfly hospitalized in the ED's clinical observation unit, and 56.6% were admitted to one of the hospital's specialty wards. 8.6% left the ED against medical advice. All of the syncope patients were evaluated by history-taking, physical examination, and 12-lead electrocardiogragraphy (ECG); ECG revealed abnormal findings in 36.4% of patients. Nearly all patients also underwent laboratory testing, which revealed hyponatremia (a serum sodium concentration under 130 mmol/L) in 5.9% and a serum creatinine level above 2 mg/dL in 5.3%. Many underwent technology-intensive tests such as cranial computed tomography (129 patients), but these tests only rarely yielded abnormal findings (3.1%). 27% of the syncope patients underwent Doppler ultrasonography of the vessels supplying the brain, with abnormal findings in 6.7% of cases. (Orthostatic testing was performed in 14.5% of the patients and was positive in 26.6%.)
Many patients presenting with syncope to a German ED are elderly, and multiple comorbidities are common. Technology-intensive testing in patients with syncope has a low diagnostic yield and consumes resources. The introduction of standards for the evaluation of syncope in the ED would be helpful.
我们研究了德国急诊科（ED）晕厥患者的特征和资源利用情况。
我们对 2009 年 5 月 15 日至 2009 年 9 月 30 日期间到纽伦堡 Klinikum 医院（德国纽伦堡市的一家公立医院）急诊科就诊的晕厥患者进行了单中心回顾性分析。
在 2009 年 5 月 15 日至 2009 年 9 月 30 日期间，共有 28477 名患者到急诊科就诊，其中 440 名（1.5%）以晕厥为主要表现。他们的平均年龄为 62 岁（标准差为 20 岁）；50.4%为女性，43.4%年龄超过 70 岁，11.8%为心源性晕厥，4.8%为神经源性晕厥，18.2%有两种以上合并症。440 名晕厥患者中，20.7%经评估后在急诊科出院，14.1%在急诊科临床观察病房短暂住院，56.6%收入医院专科病房。8.6%的患者未经医嘱离开急诊科。所有晕厥患者均接受了病史采集、体格检查和 12 导联心电图（ECG）检查；心电图异常发现率为 36.4%。几乎所有患者还进行了实验室检查，发现低钠血症（血清钠浓度＜130mmol/L）5.9%，血清肌酐水平＞2mg/dL 5.3%。许多患者接受了技术密集型检查，如头颅计算机断层扫描（129 例），但这些检查很少发现异常（3.1%）。27%的晕厥患者行脑部血管多普勒超声检查，其中 6.7%有异常发现。（14.5%的患者行直立倾斜试验，阳性率为 26.6%。）
许多到德国急诊科就诊的晕厥患者年龄较大，且常合并多种疾病。对晕厥患者进行技术密集型检查的诊断率低，且消耗资源。引入急诊科晕厥评估标准将有所帮助。
