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Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score
  1. Attilio Del Rosso (attiliodro{at}libero.it)
  1. Department of Cardiology, Azienda USL 11 Empoli, Italy
    1. Andrea Ungar
    1. Department of Geriatric Medicine and Cardiology, Universitadegli Studi di Firenze, Firenze, Italy
      1. Roberto Maggi
      1. Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
        1. Franco Giada
        1. Department of Cardiology, Ospedale Umberto I, Mestre, Italy
          1. Nunzia Rosa Petix
          1. Department of Cardiology, Azienda USL 11 Empoli, Italy
            1. Tiziana De Santo
            1. Fondazione Medtronic Italia, Roma, Italy
              1. Carlo Menozzi
              1. Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy
                1. Michele Brignole
                1. Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy

                  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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