全球精选文摘 - 对急诊就诊于全科医院患者的最初评估中关于心源性晕厥的临床预测因子：EGSYS评分

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对急诊就诊于全科医院患者的最初评估中关于心源性晕厥的临床预测因子：EGSYS评分

Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score

Del Rosso A, Ungar A, Maggi R 2009/8/14 20:26:53

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Heart, 2009,

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Objective:
To develop, in patients referred for syncope to an emergency department (ED), a diagnostic score to identify those patients likely to have a cardiac cause.

Design:
Prospective cohort study.

Setting:
ED of 14 general hospitals.

Patients:
516 consecutive patients with unexplained syncope.

Interventions:
Subjects underwent a diagnostic evaluation on adherence to Guidelines of the European Society of Cardiology. The clinical features of syncope were analysed using a standard 52-item form. In a validation cohort of 260 patients the predictive value of symptoms/ signs was evaluated, a point score was developed and then validated in a cohort of 256 other patients.

Main Outcome Measurements:
Diagnosis of cardiac syncope, mortality.

Results:
Abnormal ECG and/or heart disease, palpitations before syncope, syncope during effort or in supine position, absence of autonomic prodromes and absence of predisposing and/or precipitating factors were found to be predictors of cardiac syncope. To each variable a score from +4 to −1 was assigned to the magnitude of regression coefficient. A score ≥3 identified cardiac syncope with a sensitivity of 95%/92% and a specificity of 61%/69% in the derivation and validation cohorts, respectively. During follow-up (mean (SD) 614 (73) days) patients with score ≥3 had a higher total mortality than patients with a score <3 both in the derivation (17% vs 3%; p<0.001) and in the validation cohort (21% vs 2%; p<0.001).

Conclusions:
A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in an ED (Figs 2 and 4, Table 4).

Table 4: Predictors of Cardiac Cause of Syncope on Multivariable Analysis and Point Scores for the Diagnosis of Cardiac Syncope
Figure 2: Probability of cardiac syncope according to the EGSYS score in the derivation and validation cohorts. (Reprinted from Del Rosso A, Ungar A, Maggi R, et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008;94:1620-1626.)
Figure 4: Kaplan–Meier survival curves according to the score at presentation in the derivation (A) and validation (B) cohorts. (Reprinted from Del Rosso A, Ungar A, Maggi R, et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008;94:1620-1626.)

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高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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