Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh.
Usher Institute, University of Edinburgh, Edinburgh, UK.
Eur J Emerg Med. 2024 Apr 1;31(2):136-146. doi: 10.1097/MEJ.0000000000001101. Epub 2023 Nov 27.
In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe.
To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope).
Prospective, multicentre, observational cohort study.
Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin.
Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries.
This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.
2018 年，欧洲心脏病学会（ESC）发布了晕厥指南，首次纳入了急诊科（ED）管理。然而，人们对欧洲各地此类患者群体的特征和管理方法知之甚少。
研究成年欧洲 ED 患者因短暂性意识丧失（TLOC，未明确或疑似晕厥）就诊时的患病率、临床表现、评估、检查（心电图和实验室检查）、管理以及 ESC 和加拿大晕厥风险评分（CSRS）类别。
前瞻性、多中心、观察性队列研究。
2022 年 9 月 12 日星期一 00:01 至 9 月 25 日星期日 23:59，欧洲 14 个国家的 41 个 ED 共纳入了 98301 个 ED 就诊中出现 TLOC（未明确或疑似晕厥）的成年人（≥18 岁）。
在 2022 年 9 月 12 日星期一 00:01 至 9 月 25 日星期日 23:59 期间，欧洲 41 个 ED 共纳入了 952 名成年人，共进行了 98301 次 ED 就诊（n=40 个地点）。平均年龄（标准差）为 60.7（21.7）岁，487 名参与者为男性（51.2%）。共有 379 名（39.8%）患者住院，573 名（60.2%）患者出院。271 名（28.5%）患者先入住观察区，其中 143 名（52.8%）从观察区转入。717 名（75.3%）参与者根据 ESC 指南属于高危（不适合从 ED 出院），235 名（24.7%）属于低危。入院率随 ESC 高危因素的增加而增加；1 个 ESC 高危因素，n=259（27.2%，入院率=34.7%），2 个 ESC 高危因素，189（19.9%，38.6%），3 个 ESC 高危因素，106（11.1%，54.7%），4 个 ESC 高危因素，62（6.5%，60.4%），5 个 ESC 高危因素，48（5.0%，67.9%），6 个 ESC 高危因素及以上，53（5.6%，67.9%）。此外，660 名（69.3%）、250 名（26.3%）、34 名（3.5%）和 8 名（0.8%）参与者的 CSRS 评分分别为低、中、高和极高，相应的入院率分别为 31.4%、56.0%、76.5%和 75.0%。入院率（19.3%-88.9%）、观察/决策单位的使用（0-100%）和 ESC 高危特征百分比（64.8%-88.9%）在各国之间差异很大。
这项欧洲前瞻性队列研究报告了 ED 中晕厥的患病率为 1%。尽管各国在晕厥管理方面存在差异，但仍有 40%的患者住院。四分之三的患者具有 ESC 高危特征，入院率随 ESC 高危因素的增加而升高。
