AIMS: The goals of this study were to apply the 2001 ACEP recommendations for admission to hospital after a syncopal event and to validate the OESIL risk stratification score, in patients with syncope admitted to a general internal medicine ward. METHODS: A retrospective study applied the 2001 ACEP recommendations and OESIL score to all the patients admitted from the emergency department to a general internal medicine ward with a diagnosis of syncope during a 12-month period. The patients were classified as meeting criteria for 2001 ACEP class B or C recommendations and OESIL score 0-1 (low-risk for a major cardiac event) or 2-4 (high-risk for a major cardiac event). The sensitivity and specificity of each group for predicting high-risk patients was calculated. RESULTS: After applying the 2001 ACEP recommendations to our population, 25% (19 patients) were classified as level B, whereas 68% of the patients were classified as Level C. Sensitivity for ACEP level B recommendations was 100% and specificity was 81%. The ACEP level C recommendations also had 100% sensitivity but markedly reduced specificity at 26%. An OESIL score of 0-1 points was calculated for 30.6% of the population, identifying them as low-risk. An OESIL score of 2-4 points was documented in the remaining 69.4% with a mortality risk of 20 % /year. CONCLUSION: A significant proportion (30%) of patients presenting with syncope to a tertiary care University Hospital emergency department and admitted to an Internal Medicine ward were retrospectively classified as low-risk and could have potentially been managed as outpatients. Implementing current guidelines and clinical pathways for the management of syncope may improve this approach.
AIMS: The goals of this study were to apply the 2001 ACEP recommendations for admission to hospital after a syncopal event and to validate the OESIL risk stratification score, in patients with syncope admitted to a general internal medicine ward. METHODS: A retrospective study applied the 2001 ACEP recommendations and OESIL score to all the patients admitted from the emergency department to a general internal medicine ward with a diagnosis of syncope during a 12-month period. The patients were classified as meeting criteria for 2001 ACEP class B or C recommendations and OESIL score 0-1 (low-risk for a major cardiac event) or 2-4 (high-risk for a major cardiac event). The sensitivity and specificity of each group for predicting high-risk patients was calculated. RESULTS: After applying the 2001 ACEP recommendations to our population, 25% (19 patients) were classified as level B, whereas 68% of the patients were classified as Level C. Sensitivity for ACEP level B recommendations was 100% and specificity was 81%. The ACEP level C recommendations also had 100% sensitivity but markedly reduced specificity at 26%. An OESIL score of 0-1 points was calculated for 30.6% of the population, identifying them as low-risk. An OESIL score of 2-4 points was documented in the remaining 69.4% with a mortality risk of 20 % /year. CONCLUSION: A significant proportion (30%) of patients presenting with syncope to a tertiary care University Hospital emergency department and admitted to an Internal Medicine ward were retrospectively classified as low-risk and could have potentially been managed as outpatients. Implementing current guidelines and clinical pathways for the management of syncope may improve this approach.
Authors: M Brignole; P Alboni; D Benditt; L Bergfeldt; J J Blanc; P E Bloch Thomsen; J G van Dijk; A Fitzpatrick; S Hohnloser; J Janousek; W Kapoor; R A Kenny; P Kulakowski; A Moya; A Raviele; R Sutton; G Theodorakis; W Wieling Journal: Eur Heart J Date: 2001-08 Impact factor: 29.983
Authors: J Stephen Huff; Wyatt W Decker; James V Quinn; Andrew D Perron; Anthony M Napoli; Suzanne Peeters; Andy S Jagoda Journal: Ann Emerg Med Date: 2007-04 Impact factor: 5.721
Authors: Gonzalo Baron-Esquivias; Jesús Martínez-Alday; Alfonso Martín; Angel Moya; Roberto García-Civera; M Paz López-Chicharro; María Martín-Mendez; Carmen del Arco; Pedro Laguna Journal: Europace Date: 2010-03-09 Impact factor: 5.214
Authors: Win K Shen; Wyatt W Decker; Peter A Smars; Deepi G Goyal; Ann E Walker; David O Hodge; Jane M Trusty; Karen M Brekke; Arshad Jahangir; Peter A Brady; Thomas M Munger; Bernard J Gersh; Stephen C Hammill; Robert L Frye Journal: Circulation Date: 2004-11-09 Impact factor: 29.690