Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
JACC Clin Electrophysiol. 2018 Feb;4(2):265-273. doi: 10.1016/j.jacep.2017.09.003. Epub 2017 Nov 6.
This study sought to examine outcomes and costs of patients with syncope admitted and discharged from the emergency department (ED).
ED visits for syncope are common, yet the impact on health care utilization is relatively unknown.
A total of 51,831 consecutive patients presented to the ED with a primary diagnosis of syncope (International Classification of Diseases-9 code 780.2 and International Classification of Diseases-10 code R55) in Alberta, Canada from 2006 to 2014. Outcomes included 30-day syncope ED and hospital readmissions; 30-day and 1-year mortality; and annual inpatient, outpatient, physician, and drug costs, cumulative.
Of adults presenting to the ED, 6.6% were hospitalized and discharged with a primary diagnosis of syncope (Cohort 1), 8.7% were hospitalized and discharged with a primary diagnosis other than syncope (Cohort 2), and 84.7% were discharged home with a syncope diagnosis (Cohort 3). The 30-day ED revisits for syncope varied from 1.2% (Cohort 2) to 2.4% (Cohort 1) (p < 0.001), and readmission rates were <1% among cohorts. Short- and long-term mortality rates were highest for Cohort 2 and lowest for Cohort 3 (30-day mortality: Cohort 1 of 1.2%, Cohort 2 of 5.2%, Cohort 3 of 0.4%; p < 0.001) (1-year mortality: Cohort 1 of 9.2%, Cohort 2 of 17.7%, Cohort 3 of 3.0%; p < 0.001). Total cost of syncope presentations was $530.6 million (Cohort 1: $75.3 million; $29,519/patient, Cohort 2: $138.1 million; $42,042/patient, Cohort 3: $317.3 million; $9,963/patient; p<0.001).
Most patients with syncope presenting to the ED were discharged and had a favorable prognosis but overall costs were high compared with patients hospitalized. Further research is needed for cost-saving strategies across all cohorts.
本研究旨在探讨因晕厥而收入并出院急诊科（ED）的患者的结局和成本。
ED 因晕厥就诊的情况很常见，但对医疗保健利用的影响尚不清楚。
2006 年至 2014 年，在加拿大艾伯塔省，共有 51831 例以晕厥（国际疾病分类第 9 版代码 780.2 和国际疾病分类第 10 版代码 R55）为主要诊断的连续患者就诊 ED。结局包括 30 天晕厥 ED 和医院再入院；30 天和 1 年死亡率；以及年度住院、门诊、医生和药物费用，累计。
在就诊 ED 的成年人中，6.6%因晕厥住院并出院（队列 1），8.7%因晕厥以外的其他主要诊断住院并出院（队列 2），84.7%出院时被诊断为晕厥（队列 3）。30 天内晕厥 ED 的复诊率为 1.2%（队列 2）至 2.4%（队列 1）（p<0.001），各队列的再入院率均<1%。短期和长期死亡率以队列 2最高，队列 3最低（30 天死亡率：队列 1为 1.2%，队列 2为 5.2%，队列 3为 0.4%；p<0.001）（1 年死亡率：队列 1为 9.2%，队列 2为 17.7%，队列 3为 3.0%；p<0.001）。晕厥就诊的总费用为 5.306 亿美元（队列 1：7530 万美元；每位患者 29519 美元，队列 2：1.381 亿美元；每位患者 42042 美元，队列 3：3.306 亿美元；每位患者 9963 美元；p<0.001）。
大多数因晕厥就诊 ED 的患者出院后预后良好，但与住院患者相比，总体费用较高。需要进一步研究所有队列的节省成本策略。
