Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
Europace. 2021 May 21;23(5):797-805. doi: 10.1093/europace/euaa345.
To assess in patients with transient loss of consciousness the diagnostic yield, accuracy, and safety of the structured approach as described in the ESC guidelines in a tertiary referral syncope unit.
Prospective cohort study including 264 consecutive patients (≥18 years) referred with at least one self-reported episode of transient loss of consciousness and presenting to the syncope unit between October 2012 and February 2015. The study consisted of three phases: history taking (Phase 1), autonomic function tests (AFTs) (Phase 2), and after 1.5-year follow-up with assessment by a multidisciplinary committee (Phase 3). Diagnostic yield was assessed after Phases 1 and 2. Empirical diagnostic accuracy was measured for diagnoses according to the ESC guidelines after Phase 3. The diagnostic yield after Phase 1 (history taking) was 94.7% (95% CI: 91.1-97.0%, 250/264 patients) and increased to 97.0% (93.9-98.6%, 256/264 patients) after Phase 2. The overall diagnostic accuracy (as established in Phase 3) of the Phases 1 and 2 diagnoses was 90.6% (95% CI: 86.2-93.8%, 232/256 patients). No life-threatening conditions were missed. Three patients died, two unrelated to the cause of transient loss of consciousness, and one whom remained undiagnosed.
A clinical work-up at a tertiary syncope unit using the ESC guidelines has a high diagnostic yield, accuracy, and safety. History taking (Phase 1) is the most important diagnostic tool. Autonomic function tests never changed the Phase 1 diagnosis but helped to increase the certainty of the Phase 1 diagnosis in many patients and yield additional diagnoses in patients who remained undiagnosed after Phase 1. Diagnoses were inaccurate in 9.4%, but no serious conditions were missed. This is adequate for clinical practice.
在三级转诊晕厥中心，评估 ESC 指南中描述的结构化方法在短暂性意识丧失患者中的诊断效果、准确性和安全性。
这是一项前瞻性队列研究，纳入了 2012 年 10 月至 2015 年 2 月间因至少一次自述短暂性意识丧失就诊于晕厥单元的 264 例连续患者（≥18 岁）。该研究包括三个阶段：病史采集（第 1 阶段）、自主神经功能测试（第 2 阶段）和 1.5 年后由多学科委员会评估（第 3 阶段）。第 1 阶段和第 2 阶段后评估诊断效果。第 3 阶段后根据 ESC 指南评估各诊断的经验性诊断准确性。第 1 阶段（病史采集）的诊断效果为 94.7%（95%CI：91.1-97.0%，250/264 例），第 2 阶段后增加至 97.0%（93.9-98.6%，256/264 例）。第 1 阶段和第 2 阶段诊断的整体诊断准确性（第 3 阶段确定）为 90.6%（95%CI：86.2-93.8%，232/256 例）。未漏诊危及生命的情况。3 例患者死亡，2 例与短暂性意识丧失无关，1 例未确诊。
使用 ESC 指南在三级晕厥中心进行临床评估具有较高的诊断效果、准确性和安全性。病史采集（第 1 阶段）是最重要的诊断工具。自主神经功能测试从未改变第 1 阶段的诊断，但有助于增加许多患者第 1 阶段诊断的确定性，并为第 1 阶段后仍未确诊的患者提供额外的诊断。9.4%的诊断不准确，但未漏诊严重情况。这足以满足临床实践的需要。
