背景:晕厥是短暂的意识丧失,在晕厥前,患者经历相同的前驱症状而不失去意识。虽然研究广泛报道了急诊科(ED)晕厥的严重结局风险,对晕厥前患者的结局及其治疗方法研究不多.我们进行了系统评价,以评估患有晕厥先兆的ED患者的短期(30天)严重结局的发生/鉴定。
方法:纳入ED研究,纳入患有晕厥前患者,并报告任何短期严重转归。招募没有晕厥先兆的患者的研究(例如,低血糖,癫痫发作,和中风)被排除在外。我们的研究仅限于英文出版物,并搜索了MEDLINE,Embase,Scopus,和WebofScience从成立日期到2023年7月。我们使用SIGN50工具评估偏差风险。
结果:总计,由两名审稿人筛选了1788篇文章,并选择了32篇文章进行全文评估。纳入了5项(4项前瞻性和1项回顾性)研究,涉及2741例晕厥前患者。四项研究来自北美,第五项来自欧洲。纳入的研究由于偏见的风险而存在弱点,但都有可以接受的质量。所有成年人的总体不良结局发生率为4.4%-26.8%,老年患者为5.5%-18.7%;心律失常最为普遍(一项研究为17.4%)。其次是不同研究报告的贫血/出血。在老年患者中,在一项研究中,心肌梗死是第三大最常见的严重结局.
结论:在我们的综述中,在患有晕厥先兆的ED患者中,短期严重结局的患病率从4%到27%不等。心律失常是最常见的严重结果。我们的审查表明,晕厥前可能具有与晕厥相似的风险,因此,ED前晕厥管理应与晕厥保持同样的谨慎.
BACKGROUND: Syncope is transient loss of consciousness, and in presyncope, patients experience same prodromal symptoms without losing consciousness. While studies have extensively reported the risk of serious outcome among emergency department (ED) syncope, the outcome for patients with presyncope and their management are not well studied. We undertook a systematic
review to assess the occurrence/identification of short-term (30-day) serious outcomes among ED patients with presyncope.
METHODS: ED studies that enrolled patients with presyncope and reported any short-term serious outcome were included. Studies that enrolled patients without presyncope (e.g., hypoglycemia, seizure, and stroke) were excluded. We restricted our study to only English publications and searched the MEDLINE, Embase, Scopus, and Web of Science from the inception date to July 2023. We used SIGN 50 tool for assessment of risk of bias.
RESULTS: In total, 1788 articles were screened by two reviewers and 32 articles were selected for full-text assessment. Five (four prospective and one retrospective) studies with 2741 presyncope patients were included. Four studies were from North America and the fifth one was from Europe. Included studies had weaknesses due to risk of bias, but all had acceptable quality. The prevalence of overall adverse outcome varied 4.4%-26.8% for all adults and 5.5%-18.7% among older patients; arrhythmia was the most prevalent (17.4% in one study), followed by anemia/hemorrhage as reported in different studies. Among older patients, myocardial infarction was the third most common serious outcome reported in one study.
CONCLUSIONS: The prevalence of short-term serious outcomes varies from 4% to 27% among ED patients with presyncope in our
review, with arrhythmia being the most common serious outcome. Our
review indicates that presyncope may carry a similar risk to
syncope, and hence, the same level of caution should be exercised for ED presyncope management as
syncope.