Madeira Charles L, Craig Michael J, Donohoe Andrew, Stephens John R
New York University School of Medicine, Division of General Internal Medicine, Veterans Affairs NY Harbor Healthcare System, Manhattan Campus, New York, New York, USA.
University of North Carolina School of Medicine, Department of Internal Medicine, Division of Hospital Medicine, Chapel Hill, North Carolina, USA.
J Hosp Med. 2017 Dec;12(12):984-988. doi: 10.12788/jhm.2864. Epub 2017 Oct 18.
Syncope is a common cause of emergency department visits and hospitalizations. Echocardiogram is frequently used as a diagnostic tool in the evaluation of syncope, performed in 39% to 91% of patients. The diagnostic yield of echocardiogram for detecting clinically important abnormalities in patients with a normal history, physical examination, and electrocardiogram (ECG), however, is extremely low. In contrast, echocardiograms performed on patients with syncope with a positive cardiac history, abnormal examination, and/or ECG identify an abnormality in up to 29% of cases, though these abnormalities are not always defi nitively the cause of symptoms. Recently updated clinical guidelines for syncope management from the American College of Cardiology now recommend echocardiogram only if initial history or examination suggests a cardiac etiology, or ECG is abnormal. Universal echocardiography in patients with syncope exposes a signifi cant number of patients to unnecessary testing and cost and does not represent evidence-based or high-value patient care.
晕厥是急诊科就诊和住院的常见原因。超声心动图在晕厥评估中常被用作诊断工具，39%至91%的患者接受过该检查。然而，对于病史、体格检查和心电图（ECG）均正常的患者，超声心动图检测临床重要异常的诊断率极低。相比之下，有心脏病史、检查异常和/或心电图异常的晕厥患者进行超声心动图检查时，高达29%的病例可发现异常，尽管这些异常并不一定是症状的明确病因。美国心脏病学会最近更新的晕厥管理临床指南现在建议，只有在初始病史或检查提示心脏病因或心电图异常时才进行超声心动图检查。对晕厥患者进行普遍的超声心动图检查会使大量患者接受不必要的检查并产生费用，这并不代表基于证据或高价值的患者护理。
