急诊晕厥患者危险分层评估方法的临床应用与比较

Application and comparison of risk stratification of syncope in an emergency department

目的对比理解急诊晕厥患者的危险分层评估方法。方法应用英国ROSE规则、美国SFSR规则分别对2016-06至2018-11在北京天坛医院就诊的108例晕厥患者快速评估,对所有患者随访1个月,统计分析其灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比,并对比分析两种危险分层的规则。结果108例在1个月内有43例发生不良事件,ROSE规则评判的特异度86.2%,阴性预测值90.3%,阴性似然比0.16;而SFSR规则评判的特异度84.6%,阴性预测值85.9%,阴性似然比0.25。二种规则一致性分析的Kappa值是0.732。结论两种危险分层规则对筛查判定非高危患者均具有重要的临床意义,可以结合患者临床实际灵活运用。

Objective To compare and analyze risk stratification methods for syncope patients in an emergency department.Methods One hundred and eight patients with syncope admitted to Beijing Tiantan Hospital between June 2016 and November 2018 were assessed by ROSE rule and SFSR rule respectively.All patients were followed up for one month.The sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were analyzed and compared between the two rules.Results In this study,forty-three patients had short-term serious outcomes in one month.For ROSE rule analysis,the specificity was 86.2%,the negative predictive value was 90.3%,and the negative likelihood ratio was 0.16,compared with84.6%,85.9%and 0.25 respectively with SFSR rule.The value of concordance between the two rules was 0.732.Conclusions Both risk stratification rules are of great clinical significance for screening and judging non-high-risk patients,which can be flexibly applied according to the patients’clinical conditions.