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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Funding: This study was supported by a grant from Gruppo Italiano per lo Studio della Sincope (GIMSI).
Competing interests: Declared. TDS is an employee of Medtronic Italia. The other authors have no conflict of interest.
Ethics approval: Ethics committee approval received.
Contributors: The following people participated in the EGSYS-2 study. Steering Committee: F Ammirati, M Brignole, I Casagranda, P Cortelli, M Disertori, R Furlan, F Giada, I Iori, A Lagi, M Lunati, G Mathieu, C Menozzi, G Miceli, C Mussi, P Ponzi, A Raviere, G Re, MA Ribani, G Sandrone, A Scivales and A Ungar. A list of participating centres and investigators is reported elsewhere.3