The value of clinical characteristics from a standard questionnaire to discriminate cardiac from neurological syncope in the elderly.
OBJECTIVE
To identify signs and symptoms to differentiate cardiac from neurological syncope in patients over 70 using a standardized questionnaire.


METHODS
Prospective cohort study.


METHODS
Five short-stay units in a French university hospital.


METHODS
One hundred thirty-one in-patients with syncope aged 70 and older.


METHODS
Patients were interviewed about the signs and symptoms that had been present before, during or after syncope. When possible, a witness who had been present during syncope was also interviewed to compare theirs and the patients' answers. The sensitivity and specificity of 35 questions were calculated among 3 groups defined according to the cause of syncope: cardiac (n = 58), neurological (n = 31) and syncope of unknown origin (n = 42). Statistical analyses were performed to determine discriminating signs and symptoms among the causes and crude agreement was calculated for answers from patients and witnesses.


RESULTS
Only 8 and 3 of 35 questions had a sensitivity of at least 0.5 for cardiac and neurological causes respectively. A feeling of impending syncope, thoracic oppression, recall of events preceding syncope and a history of arrhythmia were independently and significantly discriminant among groups. Recall of events preceding syncope (Odds Ratio (OR) = 7.5; 95% confidence interval (CI) = 2.2-25.3) and a personal history of arrhythmia (OR = 4.8; 95% CI = 1.6-14.2) were discriminant between cardiac and neurological causes suggesting mostly a cardiac cause. Agreement between patients and witnesses was only found for questions on the patient's medical history or the circumstances surrounding the onset of syncope.


CONCLUSIONS
Recall of events preceding syncope and a history of arrhythmia are strongly suggestive of a cardiac rather than a neurological cause of syncope. Interviews of witnesses are not helpful in suggesting a cause for syncope.
Kadri
N
N
Service de Médecine Interne-Geriatrie-CHU Rouen-76031 Rouen cedex-France.
Chassagne
P
P
Benichou
J
J
Hellot
M F
MF
Delangre
T
T
Derambure
V
V
Druesne
L
L
Bentot
C
C
Bercoff
E
E
D000368:Aged; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*; D013575:Syncope / Q000175:diagnosis*; D019462:Syncope, Vasovagal / Q000175:diagnosis*