Dobbe Anna S M, Zwart Dorien L, van der Hem Laurens, Erkelens D Carmen, Wouters Loes T C M, van Doorn Sander, den Ruijter Hester M, Rutten Frans H
Department of General Practice & Nursing Sciences, Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
Department of General Practice & Nursing Sciences, Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.
BMJ Open. 2025 Feb 5;15(2):e092368. doi: 10.1136/bmjopen-2024-092368.
Symptoms of dizziness/lightheadedness are more often reported by females than males with an acute coronary syndrome (ACS). Therefore, we investigated if these symptoms are helpful for triage and diagnosis of ACS in females and males with acute chest discomfort.
Cross-sectional study.
Nine out-of-hours service in primary care (OHS-PC) in the Netherlands participated, covering both rural and urban areas, serving a total population of 1.5 million people.
2195 patients were selected calling the OHS-PC with acute chest discomfort, 55.4% were females. Calls were selected based on International Classification of Primary Care codes and keywords, that is, chest pain, heart complaints, heart, myocardial infarction, heart attack, heart infarction or common abbreviations of these keywords. Recordings were excluded if (1) they were of poor quality, (2) the conversation was not a triage conversation, (3) patients were <18 years, (4) patients did not live in the vicinity of the OHS-PC, and (4) general practitioners did not want to provide follow-up information including the final diagnosis.
The prevalence of dizziness/lightheadedness among patients calling the OHS-PC with acute chest discomfort and the relation between dizziness/lightheadedness and (1) urgency allocation and (2) a final diagnosis of ACS.
Among 2195 patients who called the OHS-PC with acute chest discomfort, 251 (11.4%) had an ACS (8.3% females, 15.3% males). Females more often reported concurrent dizziness/lightheadedness than males (14.7% vs 10.9%, p=0.008). However, this was not observed in those with confirmed ACS (9.9% of the females vs 9.3% of the males, p=0.881). Reporting of dizziness/lightheadedness was not positively related to an ACS diagnosis in females (OR 0.61 (95% CI 0.31 to 1.21)) or in males (OR 0.82 (95% CI 0.45 to 1.47)). In contrast, both females and males with concurrent dizziness/lightheadedness more often received a high urgency allocation than those without these symptoms.
Dizziness/lightheadedness are common symptoms but are not positively related to an ACS diagnosis in both females and males with acute chest discomfort. It seems not worthwhile to give females and males with acute chest discomfort and concurrent dizziness/lightheadedness a higher urgency allocation than those without these symptoms.
NTR7331.
急性冠状动脉综合征（ACS）患者中，女性比男性更常报告头晕/眩晕症状。因此，我们研究了这些症状对伴有急性胸痛的女性和男性ACS的分诊和诊断是否有帮助。
横断面研究。
荷兰九家初级保健非工作时间服务机构（OHS-PC）参与研究，覆盖农村和城市地区，服务总人口150万。
2195名因急性胸痛致电OHS-PC的患者被选中，其中55.4%为女性。根据国际初级保健分类代码和关键词（即胸痛、心脏不适、心脏、心肌梗死、心脏病发作、心脏梗死或这些关键词的常见缩写）选择来电。如果记录存在以下情况则被排除：（1）质量差；（2）对话不是分诊对话；（3）患者年龄小于18岁；（4）患者不住在OHS-PC附近；（4）全科医生不愿提供包括最终诊断在内的随访信息。
因急性胸痛致电OHS-PC的患者中头晕/眩晕的患病率，以及头晕/眩晕与（1）紧急程度分配和（2）ACS最终诊断之间的关系。
在2195名因急性胸痛致电OHS-PC的患者中，251人（11.4%）患有ACS（女性8.3%，男性15.3%）。女性比男性更常报告同时出现头晕/眩晕（14.7%对10.9%，p = 0.008）。然而，在确诊为ACS的患者中未观察到这种情况（女性为9.9%，男性为9.3%，p = 0.881）。女性（OR 0.61（95%CI 0.31至1.21））或男性（OR 0.82（95%CI 0.45至1.47））中，头晕/眩晕的报告与ACS诊断无正相关。相比之下，同时出现头晕/眩晕的女性和男性比没有这些症状的人更常被分配到高紧急程度。
头晕/眩晕是常见症状，但在伴有急性胸痛的女性和男性中与ACS诊断无正相关。对于伴有急性胸痛且同时出现头晕/眩晕的女性和男性，给予比没有这些症状的人更高的紧急程度似乎不值得。
NTR7331。
