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首页> 外文期刊>Canadian Journal of Emergency Medicine >LO09: Role of hospitalization for detection of serious adverse events among emergency department patients with syncope: a propensity-score matched analysis of a multicenter prospective cohort
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LO09: Role of hospitalization for detection of serious adverse events among emergency department patients with syncope: a propensity-score matched analysis of a multicenter prospective cohort

机译：LO09：住院治疗的作用，检测急诊患者晕厥患者的严重不良事件：多中心前瞻性队列的倾向评分匹配分析

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Introduction: Selecting appropriate patients for hospitalization following emergency department (ED) evaluation of syncope is critical for serious adverse event (SAE) identification. The primary objective of this study is to determine the association of hospitalization and SAE detection using propensity score (PS) matching. The secondary objective was to determine if SAE identification with hospitalization varied by the Canadian Syncope Risk Score (CSRS) risk-category. Methods: This was a secondary analysis of two large prospective cohort studies that enrolled adults (age?≥?16 years) with syncope at 11 Canadian EDs. Patients with a serious condition identified during index ED evaluation were excluded. Outcome was a 30-day SAE identified either in-hospital for hospitalized patients or after ED disposition for discharged patients and included death, ventricular arrhythmia, non-lethal arrhythmia and non-arrhythmic SAE (myocardial infarction, structural heart disease, pulmonary embolism, hemorrhage). Patients were propensity matched using age, sex, blood pressure, prodrome, presumed ED diagnosis, ECG abnormalities, troponin, heart disease, hypertension, diabetes, arrival by ambulance and hospital site. Multivariable logistic regression assessed the interaction between CSRS and SAE detection and we report odds ratios (OR). Results: Of the 8183 patients enrolled, 743 (9.0%) patients were hospitalized and 658 (88.6%) were PS matched. The OR for SAE detection for hospitalized patients in comparison to those discharged from the ED was 5.0 (95%CI 3.3, 7.4), non-lethal arrhythmia 5.4 (95%CI 3.1, 9.6) and non-arrhythmic SAE 6.3 (95%CI 2.9, 13.5). Overall, the odds of any SAE identification, and specifically non-lethal arrhythmia and non-arrhythmia was significantly higher in-hospital among hospitalized patients than those discharged from the ED (p?
机译：简介：选择应急部门（ED）康科病评估后选择适当的住院患者对严重不良事件（SAE）识别至关重要。本研究的主要目的是使用倾向评分（PS）匹配来确定住院和SAE检测的关联。次要目标是确定SAE识别是否因加拿大晕厥风险评分（CSRS）风险类别而变化。方法：这是两个大型前瞻性队列研究的二次分析，注册成年人（年龄？≥16岁），在11个加拿大EDS的晕厥。排除了在指标ED评估期间鉴定出严重病症的患者。结果是为期30天的SAE为住院治疗患者或患者ED处理后，包括死亡，室性心律失常，非致死性心律失常和非心律失常（心肌梗死，结构心脏病，肺栓塞，出血）。患者是使用年龄，性，血压，前兆，推测ED诊断，ECG异常，肌钙蛋白，心脏病，高血压，糖尿病，抵达救护车和医院遗产的倾向。多变量逻辑回归评估CSRS和SAE检测之间的相互作用，我们报告了大量比率（或）。结果：8183名患者，743名（9.0％）患者住院，658名（88.6％）均为匹配。与从ED排出的人相比，住院患者的SAE检测为5.0（95％CI 3.3,7.4），非致命性心律失常5.4（95％CI 3.1,9.6）和非心律失常SAE 6.3（95％CI） 2.9,13.5）。总体而言，任何SAE鉴定的几率，以及特异性非致死心律失常和非心律失常在住院患者中，住院患者的医院显着高于Ed的那些（P？<0.001）。 30天死亡率（P？= 1.00）或心间心律失常检测没有显着差异（p？= 0.21）。 ED处理和CSR之间的相互作用是显着的（P？= 0.04）和30天SAE的概率，而在医院的中，高风险CSRS患者更大。结论：在这种多中心前瞻性队列中，与排放患者相比，30天的SAE检测较大。 CSRS低风险患者最不可能在医院中发现SAE;适用于中度风险患者的门诊监测需要进一步研究。

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