THE EVALUATION OF 30-DAY MORTALITY AND MORBIDITY IN PATIENTS WHO PRESENT TO THE EMERGENCY DEPARTMENT WITH A SYMPTOM OF SYNCOPE

Abstract

Introduction: The aim of the present study was to investigate whether there was a significant difference in the development of a severe event during the 30-day follow-up between low-risk and high-risk patients according to the San Francisco Syncope Criteria (SFSC) who visited to our emergency department with symptoms of syncope.

Material and Methods: Patients over the age of 18 years who visited our hospital emergency department between June 2011 and September 2011 with a symptom of syncope were included in the study. The study was conducted prospectively. The patients were divided into 2 groups. Patients with a score of 1 or above on the San Francisco Syncope Criteria were accepted as the high-risk group and others as the low-risk group. The patients were followed up for 30 days after their visit to the emergency department and the severe events that developed within this period were investigated.

Results: We included 91 of the 95 patients who showed symptoms of syncope in the study. The distribution of the patients to the at-risk and no-risk groups was 26.4% and 73.6%, respectively. Follow-up of the at-risk group for 30 days revealed that 75% experienced no problem, 16.7% experienced other problems that were not severe and 8.3% died. In the no-risk group, 76.1% of the patients had no problem during the 30-day follow-up while 23.9% had other problems that were not severe and no one died.

Conclusion: The at-risk group according to San Francisco Syncope Criteria had a higher risk of a severe event developing within 30 days. Patients with high-risk factors should not be discharged and they should be hospitalized so that the etiology can be investigated.

Keywords

• Emergency,mortality,syncope

Acil Servise Senkop Şikâyeti ile Başvuran Hastalarda 30 Günlük Mortalite ve Morbidite Değerlendirilmesi

Abstract

Giriş: Bu çalışmada amacımız acil servisimize (AS) senkop şikâyeti ile başvuran San Francisco Senkop Kriterlerine (SFSK) göre düşük riskli kabul edilen hastaların yüksek riskli kabul edilenlere göre başvurudan itibaren 30 günlük takiplerinde ciddi olay gelişip gelişmediğini ve bu iki grup arasında anlamlı bir fark olup olmadığını araştırmaktır.Gereç ve Yöntem: Haziran 2011- Eylül 2011 tarihleri arasında hastanemiz acil servisine senkop şikâyeti ile başvuran 18 yaş üstü hastalar çalışmaya dâhil edildi. Çalışma prospektif olarak düzenlendi. Hastalar iki gruba ayrıldı. Birinci grup San Francisco Senkop Kriterlerine uyanlar olup, 1 puan ve üzeri alan hastalar yüksek riskli olarak, ikinci grup ise San Francisco Senkop Kriterlerine uymayan hastalar olup düşük risk grubu olarak değerlendirildi. Hastalar acil servise başvurularından itibaren bir ay süreyle takip edildi ve bu süre içerisinde gelişen ciddi olaylar araştırıldı.Bulgular: Senkop şikâyeti ile başvuran 95 hastanın 91’i çalışmaya alındı. Yüksek riskli ve düşük riskli hastaların dağılımı %26.4’e %73.6 şeklinde oldu. Riskli gruptaki hastaların 30 günlük ciddi olay gelişimi takip edildiğinde %8.3’nün öldüğü, %75’nin hiçbir sorun yaşamadığı ve %16.7’nin ise ciddi olmayan diğer sorunlar yaşadığı tespit edildi. Risksiz grubun 30 gün takiplerinde ise hiçbir hastanın ölmediği, %23.9’nun ciddi olmayan diğer sorunlar yaşadığı ve %76.1‘nin ise hiçbir sorun yaşamadığı belirlendi.Sonuç: San Francisco Senkop Kriterine göre riskli grupta olan hastaların 30 günlük süre içinde ciddi olay geçirme ihtimalleri daha yüksektir. Yüksek risk faktörlerine sahip hastaların taburcu edilmeyip, hospitalize edilerek; etiyolojiye yönelik araştırmalar yapılmasının uygun olacağını düşünmekteyiz.

Keywords

• Acil,mortalite,senkop

References

1. Quinn J. Syncope. In: Tintinalli JE, ed. Tintinalli’s Emergency Medicine. 7th ed. Section 7, New Yorke. The McGraw-Hill Companies. 2009. Chapter 56.
2. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope. Eur Heart J. 2009; 30(21): 2631-71.
3. Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice. European Heart Journal. 2000; 21(11): 935-40.
4. Gallagher EJ. Hospitalization for fainting: High stakes, low yield. Ann Emerg Med. 1997; 29: 540- 42.
5. Shen WK, Decker WW, Smars PA, et al. Syncope Evaluation in the Emergency Department Study. A multidisciplinary approach to syncope management. Circulation. 2004; 110(24): 3636-45.
6. Quinn J, McDermott D, Stiell I, Kohn M, Wells G. Prospective validation of the San Francisco syncope rule to predict with serious outcomes. An Emerg Med. 2006; 47(5): 448-54.
7. Esquivias GB, Alday JM, Martín A, et al. Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: group for syncope study in the Emergency Room (GESINUR) study. Europace. 2010; 12(6): 869-76.
8. Rodríguez-Entem F, González-Enríquez S, Olalla- Antolín JJ, et al. Management of syncope in the Emergency Department without hospital admission: usefulness of an arrhythmia unit coordinated protocol. Rev Esp Cardiol. 2008; 61(1): 22-8.

9. Benjamin C, Mangione CM, Merchant G, et al. External validation of San Francisco syncope rule. Ann Emerg Med. 2007; 49(4): 420-7.
10. Sun B, Derose SF, Liang L, et al. Predictors of 30- day perious events in older patients with syncope. Ann Emerg Med. 2009; 57(6): 769-78.
11. Reed MJ, Newby DE, Coull AJ, et al. The risk stratification of syncope in the ED pilot study: a comparison of existing syncope guideliness. Emerg Med J. 2007; 24: 270-5.
12. Leitch JW, Klein GJ, Yee R, Leather RA, Kim YH. Syncope associated with supraventricular
13. tachycardia: an expression of tachycardia or
14. vasomotor response? Circulation. 1992; 85(3): 1064-71.
15. Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008; 52(2): 151-9.
16. Sun BC, Emond JA, Camargo CA. Characteristics and admission patterns of patients presenting with syncope to US emergency departments 1992-2000. Acad Emerg Med. 2004; 11(10): 1029-34.
17. Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS. A prospective evaluation and follow-up of patients with syncope. New Engl J Med. 1983; 309(4): 197-204.
18. Eagle KA, Black HR. The impact of diagnostic tests in evaluating patients with syncope. Yale J Biol Med. 1983; 56(1): 1-8.