Personalised risk prediction following emergency department assessment for syncope
| Autor: | Phuong Anh Iris Nguyen, Anne Finlayson, Hassan Mohammad, Eric Mercier, Marco La Silviotti, Natalie Le Sage, Paul Huang, Brian H. Rowe, Mona Hegdekar, Muhammad Mukarram, Venkatesh Thiruganasambandamoorthy, Andrew D McRae, Monica Taljaard, Shahbaz Syed, Justin W. Yan, Marie-Joe Nemnom |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Canada medicine.medical_specialty 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Risk Assessment Syncope Risk category 03 medical and health sciences 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) Humans Medicine Prospective Studies Framingham Risk Score biology business.industry Area under the curve Syncope (genus) 030208 emergency & critical care medicine General Medicine Emergency department medicine.disease biology.organism_classification 3. Good health Large cohort Emergency medicine Cohort Emergency Medicine Emergency Service Hospital business |
| Zdroj: | Emergency Medicine Journal. 39:501-507 |
| ISSN: | 1472-0213 1472-0205 |
| DOI: | 10.1136/emermed-2020-211095 |
| Popis: | BackgroundPublished risk tools do not provide possible management options for syncope in the emergency department (ED). Using the 30-day observed risk estimates based on the Canadian Syncope Risk Score (CSRS), we developed personalised risk prediction to guide management decisions.MethodsWe pooled previously reported data from two large cohort studies, the CSRS derivation and validation cohorts, that prospectively enrolled adults (≥16 years) with syncope at 11 Canadian EDs between 2010 and 2018. Using this larger cohort, we calculated the CSRS calibration and discrimination, and determined with greater precision than in previous studies the 30-day risk of adjudicated serious outcomes not identified during the index ED evaluation depending on the CSRS and the risk category. Based on these findings, we developed an on-line calculator and pictorial decision aids.Results8233 patients were included of whom 295 (3.6%, 95% CI 3.2% to 4.0%) experienced 30-day serious outcomes. The calibration slope was 1.0, and the area under the curve was 0.88 (95% CI 0.87 to 0.91). The observed risk increased from 0.3% (95% CI 0.2% to 0.5%) in the very-low-risk group (CSRS −3 to –2) to 42.7% (95% CI 35.0% to 50.7%), in the very-high-risk (CSRS≥+6) group (Cochrane-Armitage trend test p20% of high/very-high-risk patients (score +4 to+11) including 4%–6% deaths. The online calculator and the pictorial aids can be found at: https://teamvenk.com/csrsConclusions30-day observed risk estimates from a large cohort of patients can be obtained for management decision-making. Our work suggests very-low-risk and low-risk patients may be discharged, discussion with patients regarding investigations and disposition are needed for medium-risk patients, and high-risk patients should be hospitalised. The online calculator, accompanied by pictorial decision aids for the CSRS, may assist in discussion with patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|