Patterns and preexisting risk factors of 30-day mortality after a primary discharge diagnosis of syncope or near syncope.

作者: Stephen F. Derose , Gelareh Z. Gabayan , Vicki Y. Chiu , Benjamin C. Sun

DOI: 10.1111/J.1553-2712.2012.01336.X

关键词:

摘要: ACADEMIC EMERGENCY MEDICINE 2012; 19:488–496 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives:  The risk of short-term mortality after an emergency department (ED) visit syncope is poorly understood, resulting in prognostic uncertainty and frequent hospital admission. authors determined patterns factors a diagnosis or near to aid medical decision-making. Methods:  A retrospective cohort study was performed adult members Kaiser Permanente Southern California seen at 11 EDs from 2002 2006 with primary discharge (International Classification Diseases, Ninth Revision [ICD-9] 780.2). outcome 30-day mortality. Proportional hazards time-to-event regression models were used identify factors. Results:  There 22,189 participants 23,951 ED visits, 307 deaths 30 days. relatively lower death reached within 2 weeks ages 18 59 years, but not until 3 months more 60 older. Preexisting comorbidities associated increased included heart failure (hazard ratio [HR] = 14.3 HR = 3.09 79 years, HR = 2.34 80 years plus; all p < 0.001), diabetes (HR = 1.49, p = 0.002), seizure (HR = 1.65, p = 0.016), dementia (HR = 1.41, p = 0.034). If index followed one visits previous 30 days, it (HR = 1.86, p = 0.024). Absolute 30 days under 0.2% those 60 years without than 2.5% across failure. Conclusions:  low patients younger old may be helpful when deciding who admit inpatient evaluation. presence that predict prior should considered clinical decisions stratification tools syncope. Close follow-up seems advisable older due prolonged death.

参考文章(48)
Joseph Cavanaugh, Survival Analysis: A Self-Learning Text (2nd ed.) Journal of the American Statistical Association. ,vol. 101, pp. 1318- 1319 ,(2006)
Urban Safwenberg, Andreas Terént, Lars Lind, Differences in long-term mortality for different emergency department presenting complaints. Academic Emergency Medicine. ,vol. 15, pp. 9- 16 ,(2008) , 10.1111/J.1553-2712.2007.00004.X
Wishwa N. Kapoor, Jacqueline Peterson, Harry S. Wieand, Michael Karpf, Diagnostic and prognostic implications of recurrences in patients with syncope. The American Journal of Medicine. ,vol. 83, pp. 700- 708 ,(1987) , 10.1016/0002-9343(87)90901-6
David J Driscoll, Steven J Jacobsen, Co-burn J Porter, Peter C Wollan, Syncope in children and adolescents Journal of the American College of Cardiology. ,vol. 29, pp. 1039- 1045 ,(1997) , 10.1016/S0735-1097(97)00020-X
Wishwa Kapoor, Diane Snustad, Jacqueline Peterson, Harry S. Wieand, Ruth Cha, Michael Karpf, Syncope in the elderly The American Journal of Medicine. ,vol. 80, pp. 419- 428 ,(1986) , 10.1016/0002-9343(86)90716-3
D. Esses, A. Birnbaum, A. Wollowitz, P. Bijur, E. J. Gallagher, Failure to Validate the San Francisco Syncope Rule in an Independent ED Population Academic Emergency Medicine. ,vol. 14, ,(2007) , 10.1197/J.AEM.2007.03.1164
Vincenzo Casini-Raggi, Gabriele Bandinelli, Alfonso Lagi, Vasovagal syncope in emergency room patients: analysis of a metropolitan area registry. Neuroepidemiology. ,vol. 21, pp. 287- 291 ,(2002) , 10.1159/000065525
Benjamin C. Sun, Stephen F. Derose, Li-Jung Liang, Gelareh Z. Gabayan, Jerome R. Hoffman, Alison A. Moore, William R. Mower, Carol M. Mangione, Predictors of 30-Day Serious Events in Older Patients With Syncope Annals of Emergency Medicine. ,vol. 54, pp. 769- 778.e5 ,(2009) , 10.1016/J.ANNEMERGMED.2009.07.027
Shamai A. Grossman, Mathew Babineau, Laura Burke, Adarsh Kancharla, Lawrence Mottley, Andrea Nencioni, Nathan I. Shapiro, Do outcomes of near syncope parallel syncope American Journal of Emergency Medicine. ,vol. 30, pp. 203- 206 ,(2012) , 10.1016/J.AJEM.2010.11.001
Holly R. Middlekauff, William G. Stevenson, Lynne Warner Stevenson, Leslie A. Saxon, Syncope in advanced heart failure: High risk of sudden death regardless of origin of syncope Journal of the American College of Cardiology. ,vol. 21, pp. 110- 116 ,(1993) , 10.1016/0735-1097(93)90724-F