PT - JOURNAL ARTICLE AU - Del Rosso, A AU - Ungar, A AU - Maggi, R AU - Giada, F AU - Petix, N R AU - De Santo, T AU - Menozzi, C AU - Brignole, M TI - Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score AID - 10.1136/hrt.2008.143123 DP - 2008 Dec 01 TA - Heart PG - 1620--1626 VI - 94 IP - 12 4099 - http://heart.bmj.com/content/94/12/1620.short 4100 - http://heart.bmj.com/content/94/12/1620.full SO - Heart2008 Dec 01; 94 AB - 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.