Jeanne du Fay de Lavallaz1, Patrick Badertscher1, Thomas Nestelberger1, Rahel Isenrich1, Òscar Miró2, Emilio Salgado2, Nicolas Geigy3, Michael Christ4, Louise Cullen5, Martin Than6, F Javier Martin-Sanchez7, José Bustamante Mandrión7, Salvatore Di Somma8, W Frank Peacock9, Damian Kawecki10, Jasper Boeddinghaus11, Raphael Twerenbold12, Christian Puelacher1, Desiree Wussler1, Ivo Strebel1, Dagmar I Keller13, Imke Poepping14, Michael Kühne15, Christian Mueller1, Tobias Reichlin16, Maria Rubini Giménez17, Joan Walter17, Nikola Kozhuharov17, Samyut Shrestha1, Deborah Mueller1, Lorraine Sazgary1, Beata Morawiec18, Piotr Muzyk18, Ewa Nowalany-Kozielska18, Michael Freese1, Claudia Stelzig1, Kathrin Meissner1, Caroline Kulangara1, Beate Hartmann1, Ina Ferel1, Zaid Sabti15, Jaimi Greenslade19, Tracey Hawkins19, Katharina Rentsch20, Arnold von Eckardstein21, Andreas Buser22, Wanda Kloos17, Jens Lohrmann15, Stefan Osswald15. 1. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; GREAT Network. 2. GREAT Network; Hospital Clinic, Barcelona, Catalonia, Spain. 3. Department of Emergency Medicine, Hospital of Liestal, Switzerland. 4. General Hospital, Paracelsus Medical University, Nürnberg, Germany. 5. GREAT Network; Royal Brisbane & Women's Hospital, Herston, Australia. 6. GREAT Network; Christchurch Hospital, Christchurch, New Zealand. 7. GREAT Network; Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain. 8. GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Italy. 9. GREAT Network; Baylor College of Medicine, Department of Emergency Medicine, Houston, USA. 10. GREAT Network; 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland. 11. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; GREAT Network; Department of Internal Medicine, University Hospital Basel, Switzerland. 12. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; GREAT Network; Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 13. Emergency Department, University Hospital Zurich, Switzerland. 14. Department of Internal Medicine, Hospital of Lachen, Switzerland. 15. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Switzerland. 16. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; GREAT Network. Electronic address: tobias.reichlin@usb.ch. 17. Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland. 18. 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland. 19. Royal Brisbane & Women's Hospital, Herston, Australia. 20. Laboratory Medicine, University Hospital Basel, Switzerland. 21. Laboratory Medicine, University Hospital Zürich, Switzerland. 22. Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland.
Abstract
BACKGROUND: Various scores have been derived for the assessment of syncope patients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS2 score. METHODS: We prospectively enrolled patients ≥ 40 years old presenting with syncope to the ED in a multicenter study. Early clinical judgment (ECJ) of the treating ED-physician regarding the probability of cardiac syncope was quantified. Two independent physicians adjudicated the final diagnosis after 1-year follow-up. Major cardiovascular events (MACE) and death were recorded during 2 years of follow-up. Nine scores were compared by their area under the receiver-operator characteristics curve (AUC) for death, MACE or the diagnosis of cardiac syncope. RESULTS: 1490 patients were available for score validation. The CHADS2-score presented a higher or equally high accuracy for death in the long- and short-term follow-up than other syncope-specific risk scores. This score also performed well for the prediction of MACE in the long- and short-term evaluation and stratified patients with accuracy comparative to OESIL, one of the best performing syncope-specific risk score. All scores performed poorly for diagnosing cardiac syncope when compared to the ECJ. CONCLUSIONS: The CHADS2-score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncope patients. While better tools incorporating biochemical and electrocardiographic markers are needed, this study suggests that the CHADS2-score is currently a good option to stratify risk in syncope patients in the ED. TRIAL REGISTRATION: NCT01548352.
BACKGROUND: Various scores have been derived for the assessment of syncopepatients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS2 score. METHODS: We prospectively enrolled patients ≥ 40 years old presenting with syncope to the ED in a multicenter study. Early clinical judgment (ECJ) of the treating ED-physician regarding the probability of cardiac syncope was quantified. Two independent physicians adjudicated the final diagnosis after 1-year follow-up. Major cardiovascular events (MACE) and death were recorded during 2 years of follow-up. Nine scores were compared by their area under the receiver-operator characteristics curve (AUC) for death, MACE or the diagnosis of cardiac syncope. RESULTS: 1490 patients were available for score validation. The CHADS2-score presented a higher or equally high accuracy for death in the long- and short-term follow-up than other syncope-specific risk scores. This score also performed well for the prediction of MACE in the long- and short-term evaluation and stratified patients with accuracy comparative to OESIL, one of the best performing syncope-specific risk score. All scores performed poorly for diagnosing cardiac syncope when compared to the ECJ. CONCLUSIONS: The CHADS2-score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncopepatients. While better tools incorporating biochemical and electrocardiographic markers are needed, this study suggests that the CHADS2-score is currently a good option to stratify risk in syncopepatients in the ED. TRIAL REGISTRATION: NCT01548352.
Authors: Venkatesh Thiruganasambandamoorthy; Marco L A Sivilotti; Natalie Le Sage; Justin W Yan; Paul Huang; Mona Hegdekar; Eric Mercier; Muhammad Mukarram; Marie-Joe Nemnom; Andrew D McRae; Brian H Rowe; Ian G Stiell; George A Wells; Andrew D Krahn; Monica Taljaard Journal: JAMA Intern Med Date: 2020-05-01 Impact factor: 21.873