Risk of post-discharge fall-related injuries among adult patients with syncope: A nationwide cohort study

BackgroundSyncope could be related to high risk of falls and injury in adults, but documentation is sparse. We examined the association between syncope and subsequent fall-related injuries in a nationwide cohort.MethodsBy cross-linkage of nationwide registers, all residents ≥18 years with a first-time diagnosis of syncope were identified between 1997–2012. Syncope patients were matched 1:1 with individuals from the general population. The absolute one-year risk of fall-related injuries, defined as fractures and traumatic head injuries requiring hospitalization, was calculated using Aalen-Johansen estimator. Ratios of the absolute one-year risk of fall-related injuries (ARR) were assessed by absolute risk regression analysis.ResultsWe identified 125,763 patients with syncope: median age 65 years (interquartile range 46–78). At one year, follow-up was complete for 99.8% where a total of 8394 (6.7%) patients sustained a fall-related injury requiring hospitalization, of which 1606 (19.1%) suffered hip fracture. In the reference group, 4049 (3.2%) persons had a fall-related injury. The one-year ARR of a fall-related injury was 1.79 (95% confidence interval 1.72–1.87, PConclusionPatients with syncope were at 80% increased risk of severe fall-related injuries within the year following discharge. Notably, increased risk was not exclusively in older patients.

**背景** 晕厥（syncope）与成人跌倒及损伤的高风险存在关联，但相关研究文献仍较为匮乏。本研究基于一项全国性队列，探讨晕厥与后续跌倒相关损伤的关联。
**方法** 通过全国登记系统的交叉关联，本研究纳入1997年至2012年间首次确诊晕厥、年龄≥18岁的所有常住居民。将晕厥患者与普通人群个体以1:1比例进行匹配。以需住院治疗的骨折及创伤性颅脑损伤定义为跌倒相关损伤，采用Aalen-Johansen估计量（Aalen-Johansen estimator）计算此类损伤的绝对一年发病风险。通过绝对风险回归分析评估跌倒相关损伤的一年期绝对风险比（absolute risk ratio, ARR）。
**结果** 本研究共纳入125763例晕厥患者，中位年龄为65岁（四分位间距（interquartile range）46~78岁）。随访满1年时，完成随访的受试者比例达99.8%，其中共计8394例（6.7%）患者出现需住院治疗的跌倒相关损伤，1606例（19.1%）为髋部骨折。对照组中共计4049例（3.2%）个体出现跌倒相关损伤。跌倒相关损伤的一年期绝对风险比为1.79（95%置信区间1.72~1.87，P）。
**结论** 晕厥患者在出院后1年内发生严重跌倒相关损伤的风险较对照人群升高80%。值得注意的是，此类风险升高并非仅局限于老年患者。