晕厥可能是肺栓塞 (PE) 的症状。目前尚不清楚使用标准化算法来排除急诊室 (ED) 收治的所有晕厥患者是否有价值，或者是否会导致过度诊断和过度治疗。我们测试了是否可以使用简单的记忆和临床参数作为在多中心观察研究中识别晕厥和肺栓塞患者的规则。该规则的敏感性在一组因肺栓塞引起的晕厥发作而到急诊科就诊的患者身上进行了测试。该规则的临床影响是在急诊室因晕厥入院的连续患者群体中进行评估的。如果存在以下任何一种情况，患者将被视为规则阳性：低血压、心动过速、外周血氧饱和度 ≤ 93% (SpO2)、胸痛、呼吸困难、近期长期卧床史、深静脉血栓形成的临床症状、既往静脉血栓栓塞史和活动性肿瘤疾病。该规则的敏感性为 90.3%（95% CI：74.3% 至 98.0%）。如果将该规则应用于 217 名晕厥患者，则需要额外诊断测试来排除肺栓塞的受试者数量将减少 70%。大多数因肺栓塞而发生晕厥的患者都具有表明肺栓塞的记忆和临床特征诊断。临床决策规则可用于识别可从进一步诊断测试中受益的患者，以排除 PE，同时减少可能导致过度测试和过度诊断的不必要检查。版权所有 © 2023。由 Elsevier B.V. 出版。

Syncope can be the presenting symptom of Pulmonary Embolism (PE). It is not known wether using a standardized algorithm to rule-out PE in all patients with syncope admitted to the Emergency Departments (ED) is of value or can lead to overdiagnosis and overtreatment.We tested if simple anamnestic and clinical parameters could be used as a rule to identify patients with syncope and PE in a multicenter observational study. The rule's sensitivity was tested on a cohort of patients that presented to the ED for syncopal episodes caused by PE. The clinical impact of the rule was assessed on a population of consecutive patients admitted for syncope in the ED.Patients were considered rule-positive in the presence of any of the following: hypotension, tachycardia, peripheral oxygen saturation ≤ 93 % (SpO2), chest pain, dyspnea, recent history of prolonged bed rest, clinical signs of deep vein thrombosis, history of previous venous thrombo-embolism and active neoplastic disease. The sensitivity of the rule was 90.3 % (95 % CI: 74.3 % to 98.0 %). The application of the rule to a population of 217 patients with syncope would have led to a 70 % reduction in the number of subjects needing additional diagnostic tests to exclude PE.Most patients with syncope due to PE present with anamnestic and clinical features indicative of PE diagnosis. A clinical decision rule can be used to identify patients who would benefit from further diagnostic tests to exclude PE, while reducing unnecessary exams that could lead to over-testing and over-diagnosis.Copyright © 2023. Published by Elsevier B.V.