OBJECTIVE: To develop, in patients referred for syncope to an emergency department (ED), a diagnostic score to identify those patients likely to have a cardiac cause. DESIGN: Prospective cohort study. SETTING: ED of 14 general hospitals. PATIENTS: 516 consecutive patients with unexplained syncope. INTERVENTIONS: Subjects underwent a diagnostic evaluation on adherence to Guidelines of the European Society of Cardiology. The clinical features of syncope were analysed using a standard 52-item form. In a validation cohort of 260 patients the predictive value of symptoms/signs was evaluated, a point score was developed and then validated in a cohort of 256 other patients. MAIN OUTCOME MEASUREMENTS: Diagnosis of cardiac syncope, mortality. RESULTS: Abnormal ECG and/or heart disease, palpitations before syncope, syncope during effort or in supine position, absence of autonomic prodromes and absence of predisposing and/or precipitating factors were found to be predictors of cardiac syncope. To each variable a score from +4 to -1 was assigned to the magnitude of regression coefficient. A score >or=3 identified cardiac syncope with a sensitivity of 95%/92% and a specificity of 61%/69% in the derivation and validation cohorts, respectively. During follow-up (mean (SD) 614 (73) days) patients with score >or=3 had a higher total mortality than patients with a score <3 both in the derivation (17% vs 3%; p<0.001) and in the validation cohort (21% vs 2%; p<0.001). CONCLUSIONS: A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in an ED.
OBJECTIVE: To develop, in patients referred for syncope to an emergency department (ED), a diagnostic score to identify those patients likely to have a cardiac cause. DESIGN: Prospective cohort study. SETTING: ED of 14 general hospitals. PATIENTS: 516 consecutive patients with unexplained syncope. INTERVENTIONS: Subjects underwent a diagnostic evaluation on adherence to Guidelines of the European Society of Cardiology. The clinical features of syncope were analysed using a standard 52-item form. In a validation cohort of 260 patients the predictive value of symptoms/signs was evaluated, a point score was developed and then validated in a cohort of 256 other patients. MAIN OUTCOME MEASUREMENTS: Diagnosis of cardiac syncope, mortality. RESULTS: Abnormal ECG and/or heart disease, palpitations before syncope, syncope during effort or in supine position, absence of autonomic prodromes and absence of predisposing and/or precipitating factors were found to be predictors of cardiac syncope. To each variable a score from +4 to -1 was assigned to the magnitude of regression coefficient. A score >or=3 identified cardiac syncope with a sensitivity of 95%/92% and a specificity of 61%/69% in the derivation and validation cohorts, respectively. During follow-up (mean (SD) 614 (73) days) patients with score >or=3 had a higher total mortality than patients with a score <3 both in the derivation (17% vs 3%; p<0.001) and in the validation cohort (21% vs 2%; p<0.001). CONCLUSIONS: A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in an ED.
Authors: Christoph Schroeder; Jens Tank; Karsten Heusser; Andreas Busjahn; André Diedrich; Friedrich C Luft; Jens Jordan Journal: Clin Auton Res Date: 2010-10-06 Impact factor: 4.435
Authors: Greta Falavigna; Giorgio Costantino; Raffaello Furlan; James V Quinn; Andrea Ungar; Roberto Ippoliti Journal: Intern Emerg Med Date: 2018-10-23 Impact factor: 3.397