Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada.
Acad Emerg Med. 2021 May;28(5):502-510. doi: 10.1111/acem.14203. Epub 2021 Jan 28.
Emergency department (ED) patients with unexplained syncope are at risk of experiencing an adverse event within 30 days. Our objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days.
We conducted a systematic review of electronic databases (MEDLINE, Cochrane, Embase, and CINAHL) from database creation until May 2020. We sought studies evaluating prediction scores of adults presenting to an ED with syncope. We included studies that followed patients for up to 30 days to identify adverse events such as death, myocardial infarction, stroke, or cardiac surgery. We only included studies with a blinded comparison between baseline clinical features and adverse events. We calculated likelihood ratios and confidence intervals (CIs).
We screened 13,788 abstracts. We included 17 studies evaluating nine risk stratification scores on 24,234 patient visits, where 7.5% (95% CI = 5.3% to 10%) experienced an adverse event. A Canadian Syncope Risk Score (CSRS) of 4 or more was associated with a high likelihood of an adverse event (LR = 11, 95% CI = 8.9 to 14). A CSRS of 0 or less (LR = 0.10, 95% CI = 0.07 to 0.20) was associated with a low likelihood of an adverse event. Other risk scores were not validated on an independent sample, had low positive likelihood ratios for identifying patients at high risk, or had high negative likelihood ratios for identifying patients at low risk.
Many risk stratification scores are not validated or not sufficiently accurate for clinical use. The CSRS is an accurate validated prediction score for ED patients with unexplained syncope. Its impact on clinical decision making, admission rates, cost, or outcomes of care is not known.
急诊科（ED）出现不明原因晕厥的患者在 30 天内发生不良事件的风险较高。我们的目的是系统地回顾多变量风险分层评分在识别未来 30 天内高风险和低风险晕厥成年患者方面的准确性。
我们对电子数据库（MEDLINE、Cochrane、Embase 和 CINAHL）进行了系统回顾，检索时间从数据库创建开始至 2020 年 5 月。我们寻找评估 ED 以晕厥就诊的成年人预测评分的研究。我们纳入了对患者进行长达 30 天随访以确定不良事件（如死亡、心肌梗死、卒中和心脏手术）的研究。我们仅纳入了基线临床特征与不良事件之间进行盲法比较的研究。我们计算了似然比和置信区间（CI）。
我们筛选了 13788 篇摘要。我们纳入了 17 项研究，共纳入了 24234 例患者就诊时的 9 种风险分层评分，其中 7.5%（95%CI=5.3%至 10%）发生了不良事件。加拿大晕厥风险评分（CSRS）为 4 分或更高与不良事件的高可能性相关（LR=11，95%CI=8.9 至 14）。CSRS 为 0 分或更低（LR=0.10，95%CI=0.07 至 0.20）与不良事件的低可能性相关。其他风险评分未在独立样本中得到验证，对高风险患者的阳性似然比较低，或对低风险患者的阴性似然比较高。
许多风险分层评分未经验证或不够准确，无法用于临床。CSRS 是一种针对 ED 不明原因晕厥患者的准确验证预测评分。其对临床决策、入院率、成本或治疗效果的影响尚不清楚。
