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Heart rhythm disorders and pacemakers
Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score
  1. A Del Rosso1,
  2. A Ungar2,
  3. R Maggi3,
  4. F Giada4,
  5. N R Petix1,
  6. T De Santo5,
  7. C Menozzi6,
  8. M Brignole3
  1. 1
    Department of Cardiology, Azienda USL 11 Empoli, Italy
  2. 2
    Department of Geriatric Medicine and Cardiology, Università degli Studi di Firenze, Firenze, Italy
  3. 3
    Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
  4. 4
    Department of Cardiology, Ospedale Umberto I, Mestre, Italy
  5. 5
    Fondazione Medtronic, Roma, Italy
  6. 6
    Department of Cardiology, Ospedale S Maria Nuova, Reggio Emilia, Italy
  1. Dr A Del Rosso, via F Cairoli 21, 50053 Vinci (FI), Italy; elettrofisiologia{at}


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

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