Gupta Arjun K, Savu Anamaria, Sheldon Robert S, Raj Satish R, Kaul Padma, Sandhu Roopinder K
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
CJC Open. 2020 May 12;2(5):365-369. doi: 10.1016/j.cjco.2020.04.012. eCollection 2020 Sep.
Syncope is a common presentation to the emergency department (ED), yet little is known regarding patient mode of arrival.
We identified patients ≥20 years old who presented to the ED with a primary diagnosis of syncope in Alberta and Ontario, Canada, between 2010 and 2016. Outcomes included 30-day in-hospital mortality, ED revisits, and rehospitalizations according to mode of arrival and discharge status. The estimated cost for ambulance use was calculated based on the provincial rates (Alberta CAD$385 and Ontario $240).
A total of 271,601 syncope presentations to the ED were identified and 60.7% arrived by ambulance. A total of 76.3% (n = 125,793) of ambulance users and 87.0% of self-presenters (n = 92,845) were discharged from the ED. Regardless of mode of arrival, discharged patients were younger with fewer comorbidities. Compared with ambulance users admitted, those discharged had lower in-hospital mortality (0.2% vs 3.5%, < 0.001), ED revisits (4.4% vs 10.4%, < 0.001), and rehospitalizations (3.6% vs 10.7%, < 0.001). Discharged self-presenters also had significantly lower outcomes ( < 0.001, for each outcome) compared with admitted self-presenters. The estimated cost for ambulance use among patients discharged from the ED was $33,137,735.
A majority of syncope patients arrived to the ED by ambulance, and over 3 quarters were directly discharged home. Although discharged patients had a favourable short-term prognosis, they incurred high transportation costs. Strategies aimed at preventing unnecessary ambulance use are needed.
晕厥是急诊科常见的就诊情况，但关于患者的就诊方式知之甚少。
我们确定了2010年至2016年期间在加拿大艾伯塔省和安大略省急诊科以晕厥为主诊断就诊的20岁及以上患者。结局包括根据就诊方式和出院状态的30天住院死亡率、急诊科复诊和再次住院情况。救护车使用的估计费用根据省级费率计算（艾伯塔省385加元，安大略省240加元）。
共确定了271,601例到急诊科就诊的晕厥患者，其中60.7%通过救护车就诊。救护车使用者中有76.3%（n = 125,793）和自行就诊者中有87.0%（n = 92,845）从急诊科出院。无论就诊方式如何，出院患者年龄较轻，合并症较少。与入院的救护车使用者相比，出院患者的住院死亡率较低（0.2%对3.5%，<0.001），急诊科复诊率较低（4.4%对10.4%，<0.001），再次住院率较低（3.6%对10.7%，<0.001）。出院的自行就诊者与入院的自行就诊者相比，结局也显著较低（每项结局均<0.001）。急诊科出院患者的救护车使用估计费用为33,137,735加元。
大多数晕厥患者通过救护车到达急诊科，超过四分之三的患者直接出院回家。虽然出院患者短期预后良好，但他们产生了高昂的交通费用。需要制定旨在防止不必要使用救护车的策略。
