Management of syncope referred urgently to general hospitals with and without syncope units

被引:87
作者
Brignole, M
Disertori, M
Menozzi, C
Raviele, A
Alboni, P
Pitzalis, MV
Delise, P
Puggioni, E
Del Greco, M
Malavasi, V
Lunati, M
Pepe, M
Fabrizi, D
机构
[1] Osped Tigullio, Dept Cardiol, I-16033 Lavagna, Italy
[2] Osped S Chiara, Dept Cardiol, Trent, Italy
[3] Osped S Maria Nuova, Dept Cardiol, Reggio Emilia, Italy
[4] Osped Umberto 1, Dept Cardiol, Venice, Italy
[5] Osped Civile, Dept Cardiol, Cento, Italy
[6] Osped Policlin Univ, Dept Cardiol, Bari, Italy
[7] Osped S Maria Battuti, Dept Cardiol, Conegliano, Italy
[8] Osped Policlin Univ, Dept Cardiol, Modena, Italy
[9] Osped Maggiore Niguarda, Dept Cardiol, Milan, Italy
[10] Medtron Italia SpA, Milan, Italy
来源
EUROPACE | 2003年 / 5卷 / 03期
关键词
syncope; diagnosis; emergency medicine; syncope unit;
D O I
10.1016/S1099-5129(03)00047-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective We tested the hypothesis that management of patients with syncope admitted urgently to a general hospital may be influenced by the presence of an in-hospital structured syncope unit. Background The management of syncope is not standardized. Methods We compared six hospitals equipped with a syncope unit organized inside the department of cardiology with six matched hospitals without such facilities. The study enroled all consecutive patients referred to the emergency room from 5 November 2001 to 7 December 2001 who were affected by transient loss of consciousness as their principal symptom. Results There were 279 patients in the syncope unit hospitals and 274 in the control hospitals. In the study group, 30 (11%) patients were referred to the syncope unit for evaluation. In the study group, 12% fewer patients were hospitalized (43 vs 49%, not significant) and 8% fewer tests were performed (3.3 +/- 2.2 vs 3.6 +/- 2.2 per patient, not significant). In particular, the study group patients underwent fewer basic laboratory tests (75 vs 36%, P = 0.002), fewer brain-imaging examinations (17 vs 24%, P = 0.05), fewer echocardiograms (I I vs 16%, P = 0.04), more carotid sinus massage (13 vs 8%, P = 0.03) and more tilt testing (8 vs 1%, P = 0.000). In the study group, there was a + 56% rate of final diagnosis of neurally mediated syncope (56 vs 36%, P = 0.000). Conclusion Although only a minority of patients admitted as an emergency are referred to the syncope unit, overall management is substantially affected. It is speculated that the use of a standardized approach, such as that typically adopted in the syncope unit, is able to influence overall practice in the hospital. (C) 2003 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:293 / 298
页数:6
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