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. 2023 May 22;99(1170):279-285. doi: 10.1136/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.
常规经胸超声心动图（TTE）在晕厥或先兆晕厥患者中资源密集。我们评估了经验证的风险评分定义的风险阈值是否可以识别出心脏异常风险低且 TTE 不必要的患者。
我们对 2016 年 7 月至 2020 年 9 月期间在一家三级医院就诊并接受 TTE 的所有综合医学晕厥/先兆晕厥患者进行了回顾性研究。加拿大晕厥风险评分（CSRS）用于将患者分为低至非常低风险（评分-3 至 0）或中至高风险（评分≥1），用于预测 30 天内严重不良事件的发生。使用 0 作为截断值来计算 CSRS 的灵敏度、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 上有临床意义发现的比值比（OR）。
在 157 名患者中，CSRS 将 69 名（44%）归类为非常低至低风险，TTE 正常。在 88 名被认为是中至高风险的患者中，TTE 检测到 24 名（27%）有心脏异常。CSRS≥1 的灵敏度为 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%），心脏异常的阳性预测值为 100%（95%CI 92.5%至 100%），异常的可能性增加一倍（OR=2.05，95%CI 1.08 至 3.87，p=0.028）。
在晕厥/先兆晕厥的综合医学患者中，使用 CSRS 分层 TTE 上心脏异常的风险可以将 TTE 的使用减少近一半。
