Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 4Z6, Canada.
Medicina (Kaunas). 2021 May 21;57(6):514. doi: 10.3390/medicina57060514.
Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12-86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.
晕厥占急诊科就诊患者的 2%，导致 12-86%的患者住院治疗。其诊断率往往较低，多达 50%的住院患者出院时仍未明确诊断。我们将概述急诊科晕厥患者的结构化方法，重点介绍支持临床判断和初始心电图（ECG）在做出初步诊断以及安全识别短期和长期不良事件风险低的患者以及如果可能从紧急干预中受益则收治患者方面的作用。临床决策工具和额外的测试可能有助于进一步对患者进行分层，并指导患者的处置。虽然住院治疗似乎并不能带来额外的生存获益，但门诊检查的有效利用可能会提供类似的诊断效果，防止不必要的住院治疗。
