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A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals.

Abstract：

AIMS:The guidelines of the European Society of Cardiology (ESC) define the current standard for the management of syncope, but are still incompletely applied in the clinical setting. METHODS AND RESULTS:Prospective systematic evaluation, on strict adherence to the guidelines, of consecutive patients referred for syncope to the emergency departments of 11 general hospitals. In order to maximize the application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correction. A diagnostic work-up consistent with the guidelines was completed in 465/541 patients (86%). A definite diagnosis was established in 98% (unexplained in 2%): neurally mediated syncope accounted for 66% of diagnosis, orthostatic hypotension 10%, primary arrhythmias 11%, structural cardiac or cardiopulmonary disease 5%, and non-syncopal attacks 6%, respectively. The initial evaluation (consisting of history, physical examination, and standard electrocardiogram) established a diagnosis in 50% of cases. Hospitalization for the management of syncope was appropriate in 25% and was required for other reasons in a further 13% of cases. The median in-hospital stay was 5.5 days (interquartile range, 3-9). Apart from the initial evaluation, a mean of 1.9+/-1.1 appropriate tests per patient was performed in 193 patients and led to a final diagnosis in 182 of these (94%). CONCLUSION:The results of this study assess the current standard for the management of syncope on the basis of a rigorous adherence to guidelines of the ESC and provide a frame of reference for daily activity when dealing with syncope.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Brignole M,Menozzi C,Bartoletti A,Giada F,Lagi A,Ungar A,Ponassi I,Mussi C,Maggi R,Re G,Furlan R,Rovelli G,Ponzi P,Scivales A

doi

10.1093/eurheartj/ehi647

subject

Has Abstract

pub_date

2006-01-01 00:00:00

pages

76-82

issue

eissn

0195-668X

issn

1522-9645

pii

ehi647

journal_volume

pub_type

杂志文章,多中心研究

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A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals.