Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA.
Ann Emerg Med. 2019 Mar;73(3):274-280. doi: 10.1016/j.annemergmed.2018.10.032. Epub 2018 Dec 7.
Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients.
From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables.
A total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope.
Near-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.
与近乎晕厥相比，晕厥患者发生不良事件的风险仍存在争议。我们研究的目的是在一个大型多中心老年急诊科（ED）患者队列中描述这两组患者之间结局的差异。
从 2013 年 4 月 28 日至 2016 年 9 月 21 日，我们对 11 个急诊科的成年人（≥60 岁）进行了一项前瞻性、观察性研究，这些患者有晕厥或近乎晕厥。使用标准化的数据提取工具在就诊时和 30 天随访时收集信息。我们的主要结局是 30 天内死亡或严重临床事件的发生率。使用描述性统计和多变量逻辑回归分析调整相关人口统计学或历史变量后分析数据。
共纳入 3581 例患者（平均年龄 72.8 岁；51.6%为男性）。其中 1380 例（39%）为近乎晕厥，2201 例（61%）为晕厥。基线特征显示，近晕厥组充血性心力衰竭、冠状动脉疾病、既往心律失常、非白人种族和就诊时呼吸困难的发生率高于晕厥组。两组主要结局无差异（近晕厥组为 18.7%，晕厥组为 18.2%）。多变量逻辑回归分析显示，近晕厥患者 30 天严重结局的发生率与晕厥患者无差异（比值比 0.94；95%置信区间 0.78 至 1.14）。
近晕厥患者的 30 天死亡或严重临床事件复合结局风险与晕厥患者相似。
