Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, United States.
Arch Gerontol Geriatr. 2014 Jan-Feb;58(1):110-4. doi: 10.1016/j.archger.2013.07.010. Epub 2013 Aug 8.
Age is often a predictor for morbidity and mortality. Although we previously proposed risk factors for adverse outcome in syncope, after accounting for the presence of these risk factors, it is unclear whether age is an independent risk factor for adverse outcomes in syncope. Our objective was to determine whether age is an independent risk factor for adverse outcome following a syncopal episode. We conducted a prospective, observational study enrolling consecutive patients with syncope. Adverse outcome/critical intervention included hemorrhage, myocardial infarction/percutaneous coronary intervention, dysrhythmia, antidysrhythmic alteration, pacemaker/defibrillator placement, sepsis, stroke, death, pulmonary embolus or carotid stenosis. Outcomes were identified by chart review and 30-day follow-up. We found that of 575 patients, adverse events occurred in 24%. Overall, 35% with risk factors had adverse outcomes compared to 1.6% without risks. Age ≥ 65 were more likely to have adverse outcomes: 34.5% versus 9.3%, p<0.001. Similarly, among patients with risk factors, elderly patients had more adverse outcomes: 43%; 36-50% versus 22%; 16-30%, p<0.001. However, among patients with no predefined risks, there were no statistical differences: 3.6%; 0.28-13% versus 1%; 0.04-3.8%. This was confirmed in a regression model accounting for the interaction between age>65 and risk factors. Although the elderly with syncope are at greater risk for adverse outcomes overall and in patients with risk factors, age ≥ 65 alone was not a predictor of adverse outcome in syncopal patients without risk factors. Based on this data, it may be safe to discharge home from the ED patients with syncope, but without risk factors, regardless of age.
年龄通常是发病率和死亡率的预测因素。尽管我们之前提出了晕厥不良预后的危险因素，但在考虑到这些危险因素的存在后，年龄是否是晕厥不良预后的独立危险因素尚不清楚。我们的目的是确定年龄是否是晕厥后不良预后的独立危险因素。我们进行了一项前瞻性、观察性研究，纳入了连续晕厥患者。不良预后/关键干预包括出血、心肌梗死/经皮冠状动脉介入治疗、心律失常、抗心律失常改变、起搏器/除颤器放置、脓毒症、中风、死亡、肺栓塞或颈动脉狭窄。通过病历回顾和 30 天随访确定结局。我们发现，在 575 例患者中，有 24%发生了不良事件。总体而言，有危险因素的患者中有 35%发生了不良结局，而无危险因素的患者中仅有 1.6%发生。年龄≥65 岁的患者更有可能发生不良结局：34.5%比 9.3%，p<0.001。同样，在有危险因素的患者中，老年患者的不良结局更多：43%；36-50%比 22%；16-30%，p<0.001。然而，在没有预先确定风险的患者中，没有统计学差异：3.6%；0.28-13%比 1%；0.04-3.8%。这在一个考虑到年龄>65 岁和危险因素之间相互作用的回归模型中得到了证实。尽管患有晕厥的老年人总体上和有危险因素的患者发生不良预后的风险更高，但年龄≥65 岁本身并不是无危险因素的晕厥患者不良预后的预测因素。根据这些数据，对于没有危险因素的晕厥患者，无论年龄大小，从 ED 出院回家可能是安全的。
