Original articles

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

Attilio Del Rosso ^1*, Andrea Ungar ², Roberto Maggi ³, Franco Giada ⁴, Nunzia Rosa Petix ¹, Tiziana De Santo ⁵, Carlo Menozzi ⁶ and Michele Brignole ³

¹ Department of Cardiology, Azienda USL 11 Empoli, Italy
² Department of Geriatric Medicine and Cardiology, Universitadegli 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 Italia, Roma, Italy
⁶ Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy

^* To whom correspondence should be addressed. E-mail: attiliodro{at}libero.it.

Accepted 29 April 2008

Abstract

Objective To develop, in patients referred for syncope to 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 other 256 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 predictors of cardiac syncope. To each variable a score from +4 to -1 was assigned on 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 cohort respectively. During follow up (614 ± 73 days) patients with score 3 had a higher total mortality than the patients with a score < 3 both in the derivation (17% vs 3%; p< .0002) and in the validation cohort (21% vs 2%; p<.00002).

Conclusions A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in ED.

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Is it cardiac? Assessment of syncope with a scoring system

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