Satish Mohan, Walters Ryan W, Alla Venkata Mahesh
Creighton University School of Medicine, Omaha, Nebraska.
Echocardiography. 2019 Jan;36(1):7-14. doi: 10.1111/echo.14208. Epub 2018 Nov 26.
We sought to assess the trends in use, predictors of echocardiography, and its impact on in-hospital mortality in patients admitted with syncope using a large national database.
Utilizing the Nationwide Inpatient Sample (NIS) database from 2001 to 2014, we identified adult patients (>18 years) with a primary discharge diagnosis of syncope and use of echocardiogram was ascertained.
A total of 3 174 619 patients with a primary discharge diagnosis of syncope were identified, of which 184 167 (5.8%) underwent an echocardiogram. The rate of syncope hospitalization remained constant between 2001 and 2009 (1.1/1000 US population) but has since decreased steadily to about 0.5/1000 US population in 2014. After adjusting for patient and hospital characteristics, the rate of echocardiogram use increased significantly from 5.1% in 2001 to 6.8% in 2014 (2.7% relative increase per year [P = 0.024]). Predictors of use were cardiac disorders, hypertension, diabetes, peripheral vascular disease, and renal failure. After adjusting for baseline risk, use of echocardiography was not associated with in-hospital mortality (OR = 0.827, P = 0.155), but was associated with a 14.6% increase in adjusted length of stay and a 22.6% increase in adjusted hospital cost compared to no echocardiography use (both P < 0.001).
The admission rates for syncope are decreasing and use of echocardiography in hospitalized patients with syncope is appropriately low. Given the lack of any favorable impact on mortality and the association with increased costs, there is a continued need to emphasize evidence-based use of echocardiography in patients presenting with syncope.
我们试图利用一个大型国家数据库评估晕厥患者超声心动图的使用趋势、预测因素及其对住院死亡率的影响。
利用2001年至2014年的全国住院患者样本（NIS）数据库，我们确定了主要出院诊断为晕厥的成年患者（>18岁），并确定了超声心动图的使用情况。
共确定了3174619例主要出院诊断为晕厥的患者，其中184167例（5.8%）接受了超声心动图检查。2001年至2009年期间，晕厥住院率保持不变（每1000名美国人口中有1.1例），但此后稳步下降，到2014年降至每1000名美国人口约0.5例。在调整患者和医院特征后，超声心动图的使用率从2001年的5.1%显著增加到2014年的6.8%（每年相对增加2.7%[P = 0.024]）。使用的预测因素包括心脏疾病、高血压、糖尿病、外周血管疾病和肾衰竭。在调整基线风险后，超声心动图的使用与住院死亡率无关（OR = 0.827，P = 0.155），但与未使用超声心动图相比，调整后的住院时间增加了14.6%，调整后的住院费用增加了22.6%（两者P < 0.001）。
晕厥的入院率在下降，住院晕厥患者中超声心动图的使用率适当较低。鉴于对死亡率没有任何有利影响且与成本增加相关，仍需要继续强调对晕厥患者进行基于证据的超声心动图使用。
