Heyer Geoffrey L, Harvey Rebecca A, Islam Monica P
Division of Pediatric Neurology, Nationwide Children's Hospital and Departments of Pediatrics and Neurology, The Ohio State University, Columbus, Ohio.
Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Am J Cardiol. 2017 Apr 1;119(7):1116-1120. doi: 10.1016/j.amjcard.2016.12.018. Epub 2017 Feb 2.
Little is known about the predictive features of psychogenic nonsyncopal collapse (PNSC). The aim of the present study was to compare the self-reported fainting characteristics between young patients who were ultimately diagnosed with PNSC with those ultimately diagnosed with neurally mediated syncope and to determine which features were predictive of either diagnosis. A prospective study was conducted of sequential patients referred for fainting. All study data were obtained before testing or diagnosis. Several fainting characteristics were compared between cohorts including numbers of lifetime fainting episodes, fainting frequency the week before evaluation, fainting duration, numbers of fainting spells in a single day, presence of presyncope, types of prodromal symptoms, tearfulness with fainting, and the numbers of emergency department visits and hospital admission for fainting. During the study period, 52 patients were diagnosed with PNSC, producing a diagnostic rate of 18.9%. In univariate analyses, multiple features differed between patients with PNSC and those with syncope. After controlling for age and gender in a multivariate analysis, each of the following predicted PNSC: ≥20 lifetime fainting spells (p = 0.005), ≥2 fainting spells in a single day (p = 0.03), self-reported loss of consciousness ≥2 minutes (p = 0.01), and tearfulness associated with fainting (p = 0.022). Two or more typical prodromal symptoms (p = 0.004) predicted syncope. In conclusion, several characteristics related to fainting have predictive value in distinguishing PNSC from syncope, particularly among youth. Assessing these clinical features can help to inform appropriate testing and accurate diagnosis among patients who faint.
关于心因性非晕厥性虚脱（PNSC）的预测特征，目前所知甚少。本研究的目的是比较最终被诊断为PNSC的年轻患者与最终被诊断为神经介导性晕厥的年轻患者自我报告的晕厥特征，并确定哪些特征可预测这两种诊断中的任何一种。对因晕厥前来就诊的连续患者进行了一项前瞻性研究。所有研究数据均在测试或诊断之前获得。比较了不同队列之间的几种晕厥特征，包括终生晕厥发作次数、评估前一周的晕厥频率、晕厥持续时间、单日晕厥发作次数、前驱晕厥的存在情况、前驱症状类型、晕厥时流泪情况以及因晕厥到急诊科就诊和住院的次数。在研究期间，52例患者被诊断为PNSC，诊断率为18.9%。在单因素分析中，PNSC患者和晕厥患者之间存在多种特征差异。在多因素分析中对年龄和性别进行校正后，以下各项均可预测PNSC：终生晕厥发作≥20次（p = 0.005）、单日晕厥发作≥2次（p = 0.03）、自我报告的意识丧失≥2分钟（p = 0.01）以及晕厥时流泪（p = 0.022）。两种或更多典型前驱症状（p = 0.004）可预测晕厥。总之，与晕厥相关的几种特征在区分PNSC和晕厥方面具有预测价值，尤其是在年轻人中。评估这些临床特征有助于为晕厥患者进行适当的检查和准确的诊断提供依据。
