Furlan Ludovico, Trombetta Lucia, Casazza Giovanni, Dipaola Franca, Furlan Raffaello, Marta Chiara, Numeroso Filippo, Pérez-Rodon Jordi, Quinn James V, Reed Matthew J, Sheldon Robert S, Shen Win-Kuang, Sun Benjamin C, Thiruganasambandamoorthy Venkatesh, Ungar Andrea, Costantino Giorgio, Solbiati Monica
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pronto Soccorso e Medicina d'Urgenza, 20122 Milan, Italy.
Scuola di Specializzazione in Medicina Interna, Università degli Studi di Milano, 20122 Milan, Italy.
Medicina (Kaunas). 2021 Nov 12;57(11):1235. doi: 10.3390/medicina57111235.
: Knowledge of the incidence and time frames of the adverse events of patients presenting syncope at the ED is essential for developing effective management strategies. The aim of the present study was to perform a meta-analysis of the incidence and time frames of adverse events of syncope patients. : We combined individual patients' data from prospective observational studies including adult patients who presented syncope at the ED. We assessed the pooled rate of adverse events at 24 h, 72 h, 7-10 days, 1 month and 1 year after ED evaluation. : We included nine studies that enrolled 12,269 patients. The mean age varied between 53 and 73 years, with 42% to 57% females. The pooled rate of adverse events was 5.1% (95% CI 3.4% to 7.7%) at 24 h, 7.0% (95% CI 4.9% to 9.9%) at 72 h, 8.4% (95% CI 6.2% to 11.3%) at 7-10 days, 10.3% (95% CI 7.8% to 13.3%) at 1 month and 21.3% (95% CI 15.8% to 28.0%) at 1 year. The pooled death rate was 0.2% (95% CI 0.1% to 0.5%) at 24 h, 0.3% (95% CI 0.1% to 0.7%) at 72 h, 0.5% (95% CI 0.3% to 0.9%) at 7-10 days, 1% (95% CI 0.6% to 1.7%) at 1 month and 5.9% (95% CI 4.5% to 7.7%) at 1 year. The most common adverse event was arrhythmia, for which its rate was 3.1% (95% CI 2.0% to 4.9%) at 24 h, 4.8% (95% CI 3.5% to 6.7%) at 72 h, 5.8% (95% CI 4.2% to 7.9%) at 7-10 days, 6.9% (95% CI 5.3% to 9.1%) at 1 month and 9.9% (95% CI 5.5% to 17) at 1 year. Ventricular arrhythmia was rare. : The risk of death or life-threatening adverse event is rare in patients presenting syncope at the ED. The most common adverse events are brady and supraventricular arrhythmias, which occur during the first 3 days. Prolonged ECG monitoring in the ED in a short stay unit with ECG monitoring facilities may, therefore, be beneficial.
了解急诊科出现晕厥的患者不良事件的发生率和时间框架对于制定有效的管理策略至关重要。本研究的目的是对晕厥患者不良事件的发生率和时间框架进行荟萃分析。：我们合并了前瞻性观察性研究中个体患者的数据，这些研究包括在急诊科出现晕厥的成年患者。我们评估了急诊科评估后24小时、72小时、7 - 10天、1个月和1年时不良事件的汇总发生率。：我们纳入了9项研究，共12269名患者。平均年龄在53岁至73岁之间，女性占42%至57%。不良事件的汇总发生率在24小时时为5.1%（95%置信区间3.4%至7.7%），72小时时为7.0%（95%置信区间4.9%至9.9%），7 - 10天时为8.4%（95%置信区间6.2%至11.3%），1个月时为10.3%（95%置信区间7.8%至13.3%），1年时为21.3%（95%置信区间15.8%至28.0%）。汇总死亡率在24小时时为0.2%（95%置信区间0.1%至0.5%），72小时时为0.3%（95%置信区间0.1%至0.7%），7 - 10天时为0.5%（95%置信区间0.3%至0.9%），1个月时为1%（95%置信区间0.6%至1.7%），1年时为5.9%（95%置信区间4.5%至7.7%）。最常见的不良事件是心律失常，其发生率在24小时时为3.1%（95%置信区间2.0%至4.9%），72小时时为4.8%（95%置信区间3.5%至6.7%），7 - 10天时为5.8%（95%置信区间4.2%至7.9%），1个月时为6.9%（95%置信区间5.3%至9.1%），1年时为9.9%（95%置信区间5.5%至17）。室性心律失常很少见。：在急诊科出现晕厥的患者中，死亡或危及生命的不良事件风险很少见。最常见的不良事件是缓慢性和室上性心律失常，这些事件发生在前3天。因此，在配备心电图监测设施的急诊科短期留观病房进行延长的心电图监测可能是有益的。
