The Management of Transient Loss of Consciousness (TLOC) and Suspected Syncope in European Emergency Departments: a Prospective Cohort Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- NHS Lothian
- 入组人数
- 952
- 试验地点
- 57
- 主要终点
- Referral source
研究概览
简要总结
Prospective multi centre cohort study examining the clinical presentation, diagnostic tests, and management of adult Emergency Department (ED) patients presenting with Transient Loss of Consciousness (TLOC) either undifferentiated or thought to be of syncopal origin.
详细描述
Syncope is a common ED problem. The three underlying causes are reflex (simple faint), orthostatic hypotension (blood pressure fall on standing) and cardiac disease (structural heart disease or cardiac dysrhythmia). Diagnosis is difficult and is not apparent in ~50% of patients after assessment. For the first time, European Society of Cardiology (ESC) guidelines incorporating ED management of patients presenting with TLOC, either undifferentiated or thought to be of syncopal origin, have been produced.
However, very little is currently known about the use of diagnostic algorithms and management of this patient group in EDs across Europe. As a result, the application of guidelines and the management of TLOC by European Society of Emergency Medicine (EUSEM) members in different countries and hospitals, cannot yet be recommended for use in settings other than those where they have been successfully validated.
This study aims to describe the prevalence, clinical presentation, current assessment, management strategies and ESC risk categories of patients presenting with TLOC (undifferentiated or thought to be of syncopal origin) to the ED, and will provide data to help identify the gaps in our knowledge and practice, and areas where further research and development work is required to fully implement European Society of Cardiology (ESC) guidelines within European EDs.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients (≥18 years old) assessed in the ED with TLOC thought to be of syncopal origin.
排除标准
- •Inability to consent
- •Patient in custody or prison
- •Aged <18 years
- •TLOC thought to be due to neurological seizure (e.g., epilepsy/alcohol or drug withdrawal) or trauma
结局指标
主要结局
Referral source
时间窗: Admission
Referral source
Participant gender
时间窗: Admission
Participant gender
Participant age
时间窗: Admission
Participant age
Mode of arrival
时间窗: Admission
Mode of arrival
ESC high-risk 'past medical history' features
时间窗: Admission
Which European Society of Cardiology syncope high-risk 'past medical history' features are present
Presence of any European Society of Cardiology (ESC) syncope high-risk history features
时间窗: Admission
Which European Society of Cardiology syncope high-risk history features are present
Other medical comorbidities
时间窗: Admission
Other medical comorbidities
Blood pressure (BP) on admission
时间窗: Admission
First Blood pressure (BP) measure in the Emergency Department in mmHg
ESC high risk 'physical examination' factors
时间窗: Admission
ESC high risk 'physical examination' factors
Troponin levels
时间窗: Admission
Troponin levels
D-dimer levels
时间窗: Admission
D-dimer levels
Copeptin levels
时间窗: Admission
Copeptin levels
Rockwood Clinical Frailty Scale score
时间窗: Admission
Rockwood Clinical Frailty Scale is a well validated score ranging from 1 (Very Fit) to 9 (Terminally Ill) with defined descriptions for each category.
Pulse rate on admission
时间窗: Admission
First pulse rate measured in the Emergency Department in beats per minute
Lying/standing systolic BP difference on admission
时间窗: Admission
First lying/standing systolic BP difference measured in the Emergency Department in mmHg
Number of participants with abnormal Electrocardiogram (ECG) readings
时间窗: Admission
Number of participants with abnormal ECG readings
Reason(s) for admission
时间窗: Admission
Reason(s) for admission
Whether driving and occupation advice given
时间窗: Admission
Whether driving and occupation advice given
Status at discharge from hospital
时间窗: 30 days
Status at discharge from hospital
Natriuretic peptides levels
时间窗: Admission
Natriuretic peptides levels
ED clinician diagnosis
时间窗: Admission
ED clinician diagnosis - descriptive
Patient destination
时间窗: Admission
Descriptive options: Admitted to Observation/Clinical Decision Unit/Same Day Emergency Care unit/hospital floor with telemetry monitoring/hospital floor with no telemetry monitoring. Discharged to outpatient follow up/family doctor/General Practitioner care/home with no follow up
Length of hospital stay in days
时间窗: 30 days
Length of hospital stay in days
Hospital discharge diagnosis
时间窗: 30 days
Hospital discharge diagnosis
次要结局
未报告次要终点