Simos Peter, Scott Ian
Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Clinical Medicine, University of Queensland Faculty of Health and Behavioural Sciences, Herston, Queensland, Australia.
Postgrad Med J. 2022 Feb 15. doi: 10.1136/postmj/postgradmedj-2021-141416.
Routine transthoracic echocardiography (TTE) in patients with syncope or presyncope is resource-intensive. We assessed if risk thresholds defined by a validated risk score may identify patients at low risk of cardiac abnormality in whom TTE is unnecessary.
We conducted a retrospective study of all general medicine patients with syncope/presyncope presenting to a tertiary hospital between July 2016 and September 2020 and who underwent TTE. The Canadian Syncope Risk Score (CSRS) was used to categorise patients as low to very low risk (score -3 to 0) or moderate to high risk (score ≥1) for serious adverse events at 30 days. A cut-point of 0 was used to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for CSRS and the odds ratio (OR) of a clinically significant finding on TTE in patients with CSRS ≥1 compared with all patients.
Among 157 patients, the CSRS categorised 69 (44%) as very low to low risk in whom TTE was normal. In 88 patients deemed moderate to high risk, TTE detected a cardiac abnormality in 24 (27%). A CSRS ≥1 yielded a sensitivity of 100% (95% CI 85.7% to 100%), specificity of 51.1% (95% CI 42.3% to 59.8%), PPV of 26.5% (95% CI 26.3% to 30.1%) and NPV of 100% (95% CI 92.5% to 100%) for cardiac abnormalities and doubled the odds of an abnormality (OR = 2.05, 95% CI 1.08 to 3.87, p = 0.028).
In general medicine patients with syncope/presyncope, using the CSRS to stratify risk of a cardiac abnormality on TTE can almost halve TTE use.
对晕厥或先兆晕厥患者进行常规经胸超声心动图（TTE）检查资源消耗大。我们评估了由经过验证的风险评分定义的风险阈值是否能识别出心脏异常风险低且无需进行TTE检查的患者。
我们对2016年7月至2020年9月期间到一家三级医院就诊且接受了TTE检查的所有晕厥/先兆晕厥普通内科患者进行了一项回顾性研究。加拿大晕厥风险评分（CSRS）用于将患者分为30天严重不良事件低至极低风险（评分-3至0）或中度至高风险（评分≥1）。以0为切点计算CSRS的敏感性、特异性、阳性和阴性预测值（PPV和NPV），以及CSRS≥1的患者与所有患者相比TTE出现临床显著发现的比值比（OR）。
在157例患者中，CSRS将69例（44%）分类为极低至低风险，这些患者的TTE检查结果正常。在88例被认为是中度至高风险的患者中，TTE检测到24例（27%）存在心脏异常。CSRS≥1对心脏异常的敏感性为100%（95%CI 85.7%至100%），特异性为51.1%（95%CI 42.3%至59.8%），PPV为26.5%（95%CI 26.3%至30.1%），NPV为100%（95%CI 92.5%至100%），且异常几率增加了一倍（OR = 2.05，95%CI 1.08至3.87，p = 0.028）。
在晕厥/先兆晕厥的普通内科患者中，使用CSRS对TTE检查时心脏异常风险进行分层可使TTE的使用量几乎减半。
