ORIGINAL ARTICLES

Heart rhythm disorders and pacemakers

Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score

A Del Rosso¹, A Ungar², R Maggi³, F Giada⁴, N R Petix¹, T De Santo⁵, C Menozzi⁶ and M Brignole³

¹ Department of Cardiology, Azienda USL 11 Empoli, Italy
² Department of Geriatric Medicine and Cardiology, Università degli Studi di Firenze, Firenze, Italy
³ Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
⁴ Department of Cardiology, Ospedale Umberto I, Mestre, Italy
⁵ Fondazione Medtronic, Roma, Italy
⁶ Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia, Italy

Correspondence to:
Dr A Del Rosso, via F Cairoli 21, 50053 Vinci (FI), Italy; elettrofisiologia{at}usl11.tos.it

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 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 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.

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Relevant Article

Is it cardiac? Assessment of syncope with a scoring system

Roman Romero-Ortuno and Rose Anne Kenny
Heart 2008 94: 1528-1529. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Benditt, D. G., Nguyen, J. T. (2009). Syncope: therapeutic approaches.. J Am Coll Cardiol 53: 1741-1751 [Abstract] [Full Text]  
• Romero-Ortuno, R., Kenny, R. A. (2008). Is it cardiac? Assessment of syncope with a scoring system. Heart 94: 1528-1529 [Full Text]