- 作者：Shamai A. Grossman ; MD ; MS&lowast ; ; ; Jessica Bar ; PhD&lowast ; ; Christopher Fischer ; MD&lowast ; ; Lewis A. Lipsitz ; MD&dagger ; ; Lawrence Mottley ; MD&lowast ; ; Kenneth Sands ; MD&Dagger ; ; Peter Zimetbaum ; MD§ ; ; Nathan I. Shapiro ; MD ; MPH&lowast ;
- 关键词：syncope ; admission ; reducing ; criteria
- 刊名：Journal of Emergency Medicine
- 出版年：2012
- 期刊代码：156_07364679
- 类别：med
- 出版时间：March, 2012
- 卷：42
- 期：3
- 页码：345-352
- 文件大小：297 K
Background
We previously developed criteria to identify patients with syncope at risk for adverse events. Although we proposed a theoretical substantial reduction in admission, these criteria were untested in actual practice.Objective
To perform a prospective effectiveness study testing the hypothesis that using the Boston Syncope Criteria as a clinical guideline will safely reduce the proportion of patients admitted with syncope.
Methods
A prospective, before-and-after cohort study of consecutive Emergency Department (ED) patients presenting with syncope. After in-service training, the Boston Syncope Criteria were implemented as a clinical guideline for emergency physicians who were encouraged to make admission decisions based on the criteria adverse outcomes at 30-day follow-up, including death, myocardial infarction/intervention, dysrhythmia or alterations in dysrhythmics, pulmonary embolus, stroke, or hemorrhage. Operating characteristics of the rule and 95%confidence intervals (CI) were calculated.
Results
In the 鈥渂efore鈥?phase, 201/293 (69%; 95%CI 63-74%) patients with syncope were admitted, compared to 160/277 (58%; 95%CI 52-64%) after the criteria were introduced; an 11%reduction in admission. Among the 160 patients admitted after the intervention, 64 (40%) had adverse events during hospitalization, compared to none in the discharged group. At 30-day follow-up, 6 additional patients (4%) had adverse outcomes; all were admitted initially. Real-time application of the criteria had a sensitivity of 100%(95%CI 94-100%), a specificity of 57%(95%CI聽50-63%), and a negative predictive value of 100%.
Conclusion
In our ED, implementing the Boston Syncope Criteria safely reduced admissions to the hospital. Future studies are needed to test external validity and generalizability.