Thiruganasambandamoorthy Venkatesh, Hess Erik P, Turko Ekaterina, Perry Jeffrey J, Wells George A, Stiell Ian G
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Emerg Med. 2013 Feb;44(2):321-8. doi: 10.1016/j.jemermed.2012.06.028. Epub 2012 Dec 4.
Little is known about the outcomes of adults with syncope seen in Canadian Emergency Departments (EDs).
We sought to determine the frequency, timing, and type of serious adverse outcomes occurring in these patients, and the proportion that occur outside the hospital.
We conducted a health records review of syncope patients presenting to a tertiary care ED over an 18-month period. We included all patients older than 16 years of age who fulfilled the syncope definition (sudden transient loss of consciousness with spontaneous complete recovery), and excluded those with altered mental status, alcohol or illicit drug use, seizure, or trauma. We assessed for outcomes in the ED and after ED disposition. We also evaluated follow-up arrangements for patients discharged from the ED.
Of the total 87,508 patient visits, 505 (0.6%) were due to syncope. The mean age was 58.5 years (range 16-101 years), 70.1% arrived by ambulance, and 12.3% were admitted to the hospital. Five patients died: 2 in the ED, 1 as an inpatient, and 2 after discharge. Overall, there were 49 (9.7%) serious outcomes, with dysrhythmias being the most common (4.6%); 22 (4.4%) occurred in the ED, 15 (3.0%) in the hospital, and 12 (2.4%) outside the hospital. Eight serious outcomes occurred in patients discharged from the ED without any planned follow-up.
Although syncope represented < 1% of all patient visits, morbidity was substantial, particularly in patients discharged from the ED. Future research should help clinicians identify syncope patients at high risk for serious outcomes.
对于在加拿大急诊科就诊的成年晕厥患者的预后情况，人们了解甚少。
我们试图确定这些患者发生严重不良后果的频率、时间和类型，以及在院外发生的比例。
我们对一家三级医疗急诊科在18个月期间就诊的晕厥患者的健康记录进行了回顾。我们纳入了所有年龄大于16岁且符合晕厥定义（突然短暂意识丧失并自发完全恢复）的患者，排除了那些有精神状态改变、饮酒或使用非法药物、癫痫发作或外伤的患者。我们评估了急诊科内和急诊科处置后的预后情况。我们还评估了从急诊科出院患者的随访安排。
在总共87,508次患者就诊中，505次（0.6%）是由于晕厥。平均年龄为58.5岁（范围16 - 101岁），70.1%由救护车送来，12.3%被收住入院。5例患者死亡：2例在急诊科，1例住院期间，2例出院后。总体而言，有49例（9.7%）严重后果，心律失常最为常见（4.6%）；22例（4.4%）发生在急诊科，15例（3.0%）在医院，12例（2.4%）在院外。8例严重后果发生在从急诊科出院且没有任何计划随访的患者中。
尽管晕厥占所有患者就诊的比例不到1%，但发病率很高，尤其是在从急诊科出院的患者中。未来的研究应有助于临床医生识别有严重后果高风险的晕厥患者。
