Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
Am J Emerg Med. 2018 Apr;36(4):551-555. doi: 10.1016/j.ajem.2017.09.015. Epub 2017 Sep 14.
Syncope is a common clinical presentation and establishing an etiology is often challenging. Pulmonary embolism (PE) has been thought to be an uncommon cause but a recent report suggested otherwise.
To establish the prevalence of PE in patients presenting with syncope to the emergency department (ED) and in hospitalized patients.
We systematically searched Medline, CINAHL, EMBASE, LILACS and Web of Science with relevant keywords and MeSH headings for syncope and PE. Inclusion criteria were patients presenting with syncope to ED or hospitalized due to syncope, and etiologies including PE.
Of 1329 titles and abstracts, 12 (other than Prandoni et al.) met inclusion criteria. Nine studies included 6608 ED patients and 3 included 975 hospitalized patients. The mean age was 62 (95% CI 54-69) for ED patients and 67 (95% CI 64-70) for hospitalized. The pooled estimate of PE prevalence in ED syncope patients was 0.8% (95% CI 0.5-1.3%, I=0%). The pooled estimate of PE prevalence in hospitalized patients was 1.0% (95% CI 0.5-1.9%, I=0). In contrast, the prevalence of PE in Prandoni et al. were 3.8% and 17.3% for ED and hospitalized patients respectively, both significantly higher than in other relevant studies (p<0.0001).
The estimated prevalence of PE in patients presenting with syncope is low. The Prandoni et al. estimates are significantly higher, suggesting a possible site effect, accrual bias, or investigation strategy. These and the prognostic impact of higher PE prevalence require understanding before changes in practice.
晕厥是一种常见的临床症状，确定病因通常具有挑战性。肺栓塞（PE）被认为是一种不常见的病因，但最近的一份报告表明并非如此。
确定因晕厥到急诊科就诊的患者和住院患者中 PE 的患病率。
我们系统地检索了 Medline、CINAHL、EMBASE、LILACS 和 Web of Science 数据库，使用与晕厥和 PE 相关的关键词和 MeSH 主题词进行检索。纳入标准为因晕厥到急诊科就诊或因晕厥住院的患者，且病因包括 PE。
在 1329 篇标题和摘要中，有 12 篇（除 Prandoni 等人的研究外）符合纳入标准。9 项研究纳入了 6608 例急诊科患者，3 项研究纳入了 975 例住院患者。急诊科晕厥患者的平均年龄为 62 岁（95%CI 54-69），住院患者的平均年龄为 67 岁（95%CI 64-70）。急诊科晕厥患者的 PE 患病率汇总估计值为 0.8%（95%CI 0.5-1.3%，I²=0%）。住院患者的 PE 患病率汇总估计值为 1.0%（95%CI 0.5-1.9%，I²=0%）。相比之下，Prandoni 等人的研究中急诊科和住院患者的 PE 患病率分别为 3.8%和 17.3%，均显著高于其他相关研究（p<0.0001）。
因晕厥就诊的患者中 PE 的估计患病率较低。Prandoni 等人的研究估计值明显较高，表明可能存在局部效应、累积偏倚或研究策略的影响。在改变实践之前，需要了解这些因素以及更高的 PE 患病率对预后的影响。
