Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands.
BMC Med. 2023 Sep 25;21(1):365. doi: 10.1186/s12916-023-03056-6.
Syncope management is fraught with unnecessary tests and frequent failure to establish a diagnosis. We evaluated the potential of implementing the 2018 European Society of Cardiology (ESC) Syncope Guidelines regarding diagnostic yield, accuracy and costs.
A multicentre pre-post study in five Dutch hospitals comparing two groups of syncope patients visiting the emergency department: one before intervention (usual care; from March 2017 to February 2019) and one afterwards (from October 2017 to September 2019). The intervention consisted of the simultaneous implementation of the ESC Syncope Guidelines with quick referral routes to a syncope unit when indicated. The primary objective was to compare diagnostic accuracy using logistic regression analysis accounting for the study site. Secondary outcome measures included diagnostic yield, syncope-related healthcare and societal costs. One-year follow-up data were used to define a gold standard reference diagnosis by applying ESC criteria or, if not possible, evaluation by an expert committee. We determined the accuracy by comparing the treating physician's diagnosis with the reference diagnosis.
We included 521 patients (usual care, n = 275; syncope guidelines intervention, n = 246). The syncope guidelines intervention resulted in a higher diagnostic accuracy in the syncope guidelines group than in the usual care group (86% vs.69%; risk ratio 1.15; 95% CI 1.07 to 1.23) and a higher diagnostic yield (89% vs. 76%, 95% CI of the difference 6 to 19%). Syncope-related healthcare costs did not differ between the groups, yet the syncope guideline implementation resulted in lower total syncope-related societal costs compared to usual care (saving €908 per patient; 95% CI €34 to €1782).
ESC Syncope Guidelines implementation in the emergency department with quick referral routes to a syncope unit improved diagnostic yield and accuracy and lowered societal costs.
Netherlands Trial Register, NTR6268.
晕厥管理充满了不必要的检查和频繁未能确定诊断。我们评估了实施 2018 年欧洲心脏病学会（ESC）晕厥指南在诊断效果、准确性和成本方面的潜力。
在荷兰的五家医院进行了一项多中心前后研究，比较了急诊科就诊的两组晕厥患者：一组为干预前（常规护理；2017 年 3 月至 2019 年 2 月），一组为干预后（2017 年 10 月至 2019 年 9 月）。干预措施包括同时实施 ESC 晕厥指南，并在需要时快速转诊到晕厥病房。主要目的是使用逻辑回归分析比较诊断准确性，同时考虑研究地点。次要结局指标包括诊断效果、与晕厥相关的医疗保健和社会成本。使用 ESC 标准或在无法进行的情况下由专家委员会评估，通过一年的随访数据来定义金标准参考诊断。我们通过比较治疗医生的诊断与参考诊断来确定准确性。
我们纳入了 521 名患者（常规护理组 275 名，晕厥指南干预组 246 名）。晕厥指南干预组的诊断准确性高于常规护理组（86% vs.69%；风险比 1.15；95%CI 1.07 至 1.23），诊断效果更高（89% vs.76%，差异的 95%CI 为 6 至 19%）。两组间晕厥相关医疗保健成本无差异，但与常规护理相比，晕厥指南的实施降低了总晕厥相关社会成本（每位患者节省 908 欧元；95%CI 34 至 1782 欧元）。
在急诊科实施 ESC 晕厥指南，并通过快速转诊到晕厥病房，提高了诊断效果和准确性，并降低了社会成本。
荷兰试验注册中心，NTR6268。
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