Relative utility of serum troponin and the OESIL score in syncope.
OBJECTIVE
To investigate the utility of both a random troponin T level taken greater than 4 h after a syncopal event and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score in predicting outcome post syncope.


METHODS
We prospectively enrolled 113 adult patients who presented to our ED after a syncopal event. Each patient had a troponin T level taken at least 4 h after the event. The relevant history of the syncope, background medical history and ECG were collected at presentation. Patients were followed up via telephone after 3-6 months and medical records were also examined. The OESIL risk score was calculated for each patient and the predictive value of both the troponin T and OESIL score were analysed for their utility post syncope.


RESULTS
Data were analysed for 100 patients. Twenty percent were believed to have a cardiac cause for their syncope. An elevated troponin T level was found to be highly specific (0.99, 95% confidence interval [CI] 0.96-1.0) for adverse cardiac outcome, but with a very low sensitivity (0.13, 95% CI 0-0.3). The OESIL risk score was found to be predictive of an adverse cardiac outcome (receiver-operating characteristic [ROC] 0.73, 95% CI 0.63-0.84) and return to normal function (ROC 0.74, 95% CI 0.63-0.86).


CONCLUSIONS
A normal serum troponin T has a poor negative predictive value for adverse cardiac outcomes following syncope. A simple risk stratification system, such as the OESIL score, can predict those patients most at risk after a syncopal episode.
Hing
Rosslyn
R
Emergency Department, Royal North Shore Hospital, Missenden Road, Camperdown, St Leonards, New South Wales 2050, Australia. rosslyn.hing@email.cs.nsw.gov.au
Harris
Roger
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004635:Emergency Medicine / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013575:Syncope / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D014336:Troponin / Q000097:blood*
D014336:Troponin