Practical Approaches to Care in Emergency Syncope (PACES)

紧急晕厥的实用护理方法 (PACES)

• 批准号: 10445071
• 负责人: Marc Probst
• 金额: $ 79.78万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10445071
• 关键词: Accident and Emergency department; Admission activity; Adult; Age; Algorithms; Arrhythmia; Benign; Cardiac; Caring; Clinical; Clinical Data; Clinical Management; Data; Derivation procedure; Emergency Care; Emergency Department patient; Emergency Situation; Emergency department visit; Enrollment; Esthesia; Evaluation; Funding; Goals; Health Care Costs; Health system; Home; Hospitalization; Hospitals; Iatrogenesis; Intervention; Judgment; Knowledge; Laboratories; Measures; Medical; Methodology; Minority; Myocardial Infarction; Names; National Heart, Lung, and Blood Institute; Observational Study; Outcome; Patients; Performance; Physicians; Play; Population; Publishing; Pulmonary Embolism; Pulmonary Heart Disease; Quality of Care; Research; Research Assistant; Research Personnel; Research Training; Resources; Risk; Role; Sensitivity and Specificity; Site; Syncope; Testing; Unconscious State; United States; Validation; Visit; acute coronary syndrome; base; clinical care; clinical implementation; clinical practice; cost; experience; health care service utilization; health record; health service use; high risk; improved; novel; patient population; patient safety; patient stratification; prospective; response; risk stratification; tool

Project Summary/Abstract The goal of this project is to improve risk-stratification for patients who present to the emergency department (ED) with syncope (transient loss of consciousness), in order to better delineate which patients require admission and which can be safely discharged home. Syncope and pre-syncope (the sensation of impending loss of consciousness) are common reasons to present to the ED, representing over 1.3 million visits per year in the United States. Although syncope is most often benign, it can occasionally be caused by serious cardiopulmonary diseases such as cardiac arrhythmia, acute coronary syndrome, or pulmonary embolism. Despite thorough evaluation in the ED, the cause of syncope remains unknown in over 50% of cases, which leads to a large number of syncope patients being admitted for observation and/or further testing. These admissions to the hospital or observation unit are low-yield, costly, and expose patients to the possibility of iatrogenic harm. In response to this, two groups of researchers have developed distinct syncope risk-stratification tools: the US Syncope Risk Score and the Canadian Syncope Risk Score. These scores use a combination of clinical, electrocardiographic, and laboratory variables to predict the risk of serious clinical outcomes at 30 days. While promising, these two risk scores require external validation prior to widespread clinical implementation. In Aim 1 of this proposal, we will prospectively collect clinical data on 1,600 ED patients with syncope/pre-syncope and follow them for 30 days to validate the predictive accuracy of these two risk scores. In Aim 2, we will assess the impact of implementing these scores by measuring their potential effect on healthcare utilization and costs. Existing care will be used as the reference strategy and will be compared with a simple risk-based clinical algorithm: Direct discharge for low risk patients (under 2% risk of serious outcome at 30 days), and hospitalization for medium- and high-risk patients. If validated and shown to safely reduce healthcare utilization, these syncope risk scores could play a major role in improving emergency syncope care by reducing low-yield admissions and identifying patients who are unsafe for discharge from the ED. This study, entitled PACES: Practical Approaches to Care in Emergency Syncope, will help increase the quality and value of emergency care, and advance the field of syncope research.

项目摘要/摘要 该项目的目的是改善出现在急诊室的患者的风险分层 （ed）与晕厥（瞬态意识丧失），以便更好地描绘患者需要的 入场并可以安全出院。晕厥和前同步（即将发生的感觉 意识的丧失）是向急诊室展示的常见原因，每年访问超过130万 在美国。 尽管晕厥通常是良性的，但偶尔可能是由严重的心肺疾病引起的 例如心律不齐，急性冠状动脉综合征或肺栓塞。尽管有彻底的评估 在超过50％的情况下，副杂志的原因仍然未知，这导致了大量 晕厥患者被接纳进行观察和/或进一步测试。这些入院或 观察单位是低收益，昂贵的，并使患者暴露于医源性伤害的可能性。 为此，两组研究人员开发了独特的晕厥风险分层工具：美国 晕厥风险评分和加拿大晕厥风险评分。这些分数结合了临床， 心电图和实验室变量预测30天的严重临床结果的风险。尽管 有希望的是，这两个风险得分需要在广泛的临床实施之前进行外部验证。目标 1本提案中，我们将对1,600例晕厥/同伴前患者进行前瞻性收集临床数据 并跟随它们30天，以验证这两个风险评分的预测准确性。在AIM 2中，我们将 通过测量其对医疗保健利用的潜在影响来评估实施这些分数的影响 和成本。现有的护理将用作参考策略，并将与简单的基于风险的简单 临床算法：低风险患者的直接出院（在30天后出现严重预后的2％风险）和 中型和高危患者的住院。 如果经过验证并证明可以安全地减少医疗保健利用，这些晕厥风险得分可能会发挥重要作用 通过减少低收益入院并确定是 不安全的出院。这项研究，标题为速度：紧急情况下的实际护理方法 晕厥，将有助于提高紧急护理的质量和价值，并提高晕厥领域 研究。