急诊部门晕厥的处理:一项欧洲前瞻性队列研究(SEED)。

IF 3.1 4区 医学 Q1 EMERGENCY MEDICINE
European Journal of Emergency Medicine Pub Date : 2024-04-01 Epub Date: 2023-11-27 DOI:10.1097/MEJ.0000000000001101
Matthew J Reed, Suvi Karuranga, David Kearns, Salma Alawiye, Ben Clarke, Martin Möckel, Mehmet Karamercan, Kelly Janssens, Luis Garcia-Castrillo Riesgo, Francisco Moya Torrecilla, Adela Golea, Juan Antonio Fernández Cejas, Eugenia Maria Lupan-Muresan, Edmond Zaimi, Alexander Nuernberger, Ondřej Rennét, Christian Skjaerbaek, Effie Polyzogopoulou, Judit Imecz, Paolo Groff, Rene Camilleri, Diana Cimpoesu, Miljan Jovic, Òscar Miró, Rory Anderson, Said Laribi
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引用次数: 0

摘要

背景和重要性:2018年,欧洲心脏病学会(ESC)制定了首次纳入急诊科(ED)管理的晕厥指南。然而,在整个欧洲,人们对这一患者群体的特征和管理知之甚少。目的:探讨以短暂性意识丧失(TLOC,未分化或疑似晕厥)为表现的成年欧洲ED患者的患病率、临床表现、评估、调查(心电图和实验室检查)、管理、ESC和加拿大晕厥风险评分(CSRS)分类。设计:前瞻性、多中心、观察队列研究。背景和参与者:成人(≥18岁)就诊于欧洲ed, TLOC未分化或被认为是晕厥起源。主要结果:在2022年9月12日周一00:01至9月25日周日23:59期间,来自14个欧洲国家41个急诊科的952名患者从98 301例急诊科就诊(n = 40个站点)纳入研究。平均年龄(SD)为60.7(21.7)岁,男性487人(51.2%)。住院379例(39.8%),出院573例(60.2%)。271例(28.5%)先入观察病房,其中143例(52.8%)由观察病房入院。根据ESC指南,717名(75.3%)参与者为高风险(不适合从急诊科出院),235名(24.7%)参与者为低风险。住院率随ESC高危因素的增加而增加;1 ESC高危因素;N = 259(27.2%,录取率34.7%),2;189 (19.9%;38.6%), 3;106例(11.1%,54.7%,4;62 (6.5%, 60.4%), 5;48例(5.0%,67.9%,6+);53例(5.6%,67.9%)。有660人(69.3%)、250人(26.3%)、34人(3.5%)和8人(0.8%)具有低、中、高和极高的CSRS,录取率分别为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%)和高风险百分比(64.8-88.9%)在各国之间差异很大。结论:这项欧洲前瞻性队列研究报告了急诊科的晕厥患病率为1%。尽管各国在晕厥管理方面存在很大差异,但每10名患者中有4名住院。四分之三的患者具有ESC高危特征,随ESC高危因素的增加,入院比例也在上升。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of syncope in the Emergency Department: a European prospective cohort study (SEED).

Background and importance: 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.

Objectives: 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).

Design: Prospective, multicentre, observational cohort study.

Settings and participants: Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin.

Main results: 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.

Conclusion: 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.

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来源期刊
CiteScore
3.60
自引率
27.30%
发文量
180
审稿时长
6-12 weeks
期刊介绍: The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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