Grossman Shamai A, Babineau Matthew, Burke Laura, Kancharla Adarsh, Mottley Lawrence, Nencioni Andrea, Shapiro Nathan I
Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
J Emerg Med. 2012 Dec;43(6):958-63. doi: 10.1016/j.jemermed.2012.01.043. Epub 2012 Sep 13.
We recently demonstrated that near-syncope patients are as likely as syncope patients to experience adverse outcomes. The Boston Syncope Criteria (BSC) identify patients with syncope unlikely to have adverse outcomes and reduce hospitalizations. It is unclear whether these guidelines could reduce hospitalization in near syncope as well.
To determine if BSC accurately predict which near-syncope patients require hospitalization.
A prospective observational study enrolled from August 2007 to October 2008 consecutive emergency department (ED) patients (aged > 18 years) with near syncope. BSC were first employed assuming that any patient with risk factors for adverse outcomes should be admitted, and then utilized using a modified rule: if the etiology of near syncope is dehydration or vasovagal, and ED work-up is normal, patients may be discharged even with risk factors. Outcomes were identified by chart review and 30-day follow-up calls.
Of 244 patients with near syncope, 111 were admitted, with 49 adverse outcomes. No adverse outcomes occurred among discharged patients. If BSC had been followed strictly, another 41 patients with risk factors would have been admitted and 34 discharged, a 3% increase in admission rate. However, using the modified criteria, only 68 patients would have required admission, a 38% reduction in admission, with no missed adverse outcomes on follow-up.
Although near-syncope patients may have risk factors for adverse outcomes similar to those with syncope, if the etiology of near syncope is dehydration or vasovagal, and ED work-up is normal, these patients may be discharged even with risk factors.
我们最近证明，接近晕厥的患者与晕厥患者发生不良结局的可能性相同。波士顿晕厥标准（BSC）可识别出晕厥患者中不太可能出现不良结局的患者，并减少住院治疗。目前尚不清楚这些指南是否也能减少接近晕厥患者的住院率。
确定BSC能否准确预测哪些接近晕厥的患者需要住院治疗。
一项前瞻性观察性研究纳入了2007年8月至2008年10月急诊科连续收治的年龄大于18岁的接近晕厥患者。首先采用BSC，假设任何有不良结局危险因素的患者都应入院，然后使用修改后的规则：如果接近晕厥的病因是脱水或血管迷走性晕厥，且急诊科检查正常，即使有危险因素患者也可出院。通过病历审查和30天随访电话确定结局。
244例接近晕厥患者中，111例入院，49例出现不良结局。出院患者中未出现不良结局。如果严格遵循BSC，另外41例有危险因素患者将入院，34例将出院，入院率增加3%。然而，使用修改后的标准，仅68例患者需要入院，入院率降低38%，随访中未遗漏不良结局。
虽然接近晕厥患者可能具有与晕厥患者相似的不良结局危险因素，但如果接近晕厥的病因是脱水或血管迷走性晕厥，且急诊科检查正常，即使有危险因素这些患者也可出院。
