Ungar Andrea, Tesi Francesca, Chisciotti Valentina Maddalena, Pepe Giuseppe, Vanni Simone, Grifoni Stefano, Balzi Daniela, Rafanelli Martina, Marchionni Niccolò, Brignole Michele
Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy
Syncope Unit, Unit of Geriatric Cardiology and Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital and University of Florence, Viale Pieraccini 6, Florence 50141, Italy.
Europace. 2016 Mar;18(3):457-62. doi: 10.1093/europace/euv106. Epub 2015 May 14.
High hospitalization rates (39-58% in the literature) of patients admitted to Emergency Department (ED) for transient loss of consciousness (T-LOC) suspected for syncope are still an unresolved issue. The presence of an Observation Unit has reduced hospital admissions and the duration of hospitalization in controlled studies, and a Syncope Unit (SU) in the hospital may reduce hospitalization and increase the number of diagnoses in patients with T-LOC. We assessed the effect of a structured organization on hospitalization rate and outcome.
Consecutive patients referred to the ED for a T-LOC of a suspected syncopal nature as the main diagnosis were included. The ED physician was trained to choose between: hospital admission (directly or after short observation); discharge after short (<48-h) observation; discharge on a fast track to the SU; and direct discharge without any further diagnostics. From January to June 2010, 362 patients were evaluated in the ED: 29% were admitted, 20% underwent short observation in the ED, 20% were referred to the SU, and 31% were directly discharged. Follow-up data were available on 295 patients who were discharged alive: of these, 1 (0.3%) previously hospitalized patient died within 30 days and 16 (5.4%) died within 1 year. Death rates were 12.9, 3.3, 0, and 2.5% among admitted, observation, SU, and ED-discharged patients, respectively. No death could be directly attributed to T-LOC. Re-admission within 1 year for any cause occurred in 72 (24%) patients; re-admission rates were 45.9, 19.3, 11.5, and 18.0% among admitted, observation, SU, and ED-discharged patients, respectively.
The availability of short observation and a SU seems to reduce the hospitalization rate compared with previous reported historical reports from our and other centres. Most deaths during follow-up occurred in patients who had been hospitalized. High rates of re-admission to the ED within 1 year are still an issue.
因疑似晕厥的短暂意识丧失（T-LOC）而入住急诊科（ED）的患者住院率较高（文献报道为39%-58%），这仍是一个未解决的问题。在对照研究中，观察单元的设立降低了住院率和住院时间，医院内的晕厥单元（SU）可能会降低T-LOC患者的住院率并增加诊断数量。我们评估了结构化组织对住院率和结局的影响。
纳入以疑似晕厥性质的T-LOC作为主要诊断而转诊至急诊科的连续患者。急诊科医生接受培训，以便在以下情况中做出选择：住院（直接住院或短期观察后住院）；短期（<48小时）观察后出院；快速转诊至SU；直接出院且无需进一步诊断。2010年1月至6月，急诊科共评估了362例患者：29%的患者住院，20%的患者在急诊科接受短期观察，20%的患者转诊至SU，31%的患者直接出院。对295例存活出院患者进行了随访：其中，1例（0.3%）曾住院患者在30天内死亡，16例（5.4%）在1年内死亡。住院、观察、SU和急诊科出院患者的死亡率分别为12.9%、3.3%、0和2.5%。没有死亡可直接归因于T-LOC。72例（24%）患者因任何原因在1年内再次入院；住院、观察、SU和急诊科出院患者的再入院率分别为45.9%、19.3%、11.5%和18.0%。
与我们中心和其他中心之前报道的历史数据相比，短期观察和SU的设立似乎降低了住院率。随访期间的大多数死亡发生在住院患者中。1年内急诊科的高再入院率仍是一个问题。
