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, 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

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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:

• Developed in collaboration with, , European Heart Rhythm Association (EHRA), , Heart Failure Association (HFA), , and Heart Rhythm Society (HRS), , Endorsed by the following societies, , European Society of Emergency Medicine (EuSEM), , European Federation of Internal Medicine (EFIM), , European Union Geriatric Medicine Society (EUGMS), , American Geriatrics Society (AGS), , European Neurological Society (ENS), , European Federation of Autonomic Societies (EFAS), , American Autonomic Society (AAS), , Authors/Task Force Members, , Moya, A., Sutton, R., Ammirati, F., Blanc, J.-J., Brignole, M., Dahm, J. B., Deharo, J.-C., Gajek, J., Gjesdal, K., Krahn, A., Massin, M., Pepi, M., Pezawas, T., Granell, R. R., Sarasin, F., Ungar, A., van Dijk, J. G., Walma, E. P., Wieling, W., External Contributors, , Abe, H., Benditt, D. G., Decker, W. W., Grubb, B. P., Kaufmann, H., Morillo, C., Olshansky, B., Parry, S. W., Sheldon, R., Shen, W. K., ESC Committee for Practice Guidelines (CPG), , Vahanian, A., Auricchio, A., Bax, J., Ceconi, C., Dean, V., Filippatos, G., Funck-Brentano, C., Hobbs, R., Kearney, P., McDonagh, T., McGregor, K., Popescu, B. A., Reiner, Z., Sechtem, U., Sirnes, P. A., Tendera, M., Vardas, P., Widimsky, P., Document Reviewers, , Auricchio, A., Acarturk, E., Andreotti, F., Asteggiano, R., Bauersfeld, U., Bellou, A., Benetos, A., Brandt, J., Chung, M. K., Cortelli, P., Da Costa, A., Extramiana, F., Ferro, J., Gorenek, B., Hedman, A., Hirsch, R., Kaliska, G., Kenny, R. A., Kjeldsen, K. P., Lampert, R., Molgard, H., Paju, R., Puodziukynas, A., Raviele, A., Roman, P., Scherer, M., Schondorf, R., Sicari, R., Vanbrabant, P., Wolpert, C., Zamorano, J. L. (2009). Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur Heart J 30: 2631-2671 [Full Text]  
• Mendu, M. L., McAvay, G., Lampert, R., Stoehr, J., Tinetti, M. E. (2009). Yield of Diagnostic Tests in Evaluating Syncopal Episodes in Older Patients. Arch Intern Med 169: 1299-1305 [Abstract] [Full Text]  
• Benditt, D. G., Nguyen, J. T. (2009). Syncope: therapeutic approaches.. J Am Coll Cardiol 53: 1741-1751 [Abstract] [Full Text]  
• Brignole, M., Blanc, J.-J., Sutton, R., Moya, A. (2009). CHAPTER 26 Syncope. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [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]