A New Feasible Syncope Risk Score Appropriate for Emergency Department: A Prospective Cohort Study

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Abstract

Background:

We aimed to compare current syncope risk stratification scores and propose a new more feasible and easy-to-use one.

Methods:

In this prospective cohort study, we enrolled all patients (≥18 years) with chief complaint of syncope if they were not eligible for admission in terms of high-risk features. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores were compared in our population.

Results:

Overall, 356 patients (mean age: 44.5 years, 46.3% male) were followed for 3 months. Serious adverse events occurred in 26 (7.3%) patients including 4 deaths. Odds ratio for adverse events was 6.8 [95% confidence interval (CI), 2.8–16.1; P < 0.001; area under the curve (AUC): 66.3], 7.7 (95% CI, 3.2–18; P < 0.001; AUC: 72.8), and 18 (95% CI, 7.1–45.4; P < 0.001; AUC: 70.8) when considering San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores as the predicting tools, respectively. We proposed a relatively more feasible risk score (presenting symptoms, history of cardiovascular diseases, ejection fraction <50%, and predefined electrocardiography abnormalities). According to this syncope score, odds ratio for occurring adverse events was 20.9 (95% CI, 8.4–52; P < 0.001; AUC: 79.8).

Conclusions:

The 3 syncope risk scores could somehow predict 3-month adverse events. We found more feasible indicators that could predict serious events better. It suits well for emergency department.

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