title: Predicting adverse outcomes in syncope.
abstract: Syncope is a common presentation to the Emergency Department (ED); however, appropriate management and indications for hospitalization remain an ongoing challenge. The objective of this study was to determine if a predefined decision rule could accurately identify patients with syncope likely to have an adverse outcome or critical intervention. A prospective, observational, cohort study was conducted of consecutive ED patients aged 18 years or older presenting with syncope. A clinical decision rule was developed a priori to identify patients at risk if they met any of the following 8 criteria: 1) Signs and symptoms of acute coronary syndrome; 2) Signs of conduction disease; 3) Worrisome cardiac history; 4) Valvular heart disease by history or physical examination; 5) Family history of sudden death; 6) Persistent abnormal vital signs in the ED; 7) Volume depletion; 8) Primary central nervous system event. The primary outcome was either a critical intervention or an adverse outcome within 30 days. Among 362 patients enrolled with syncope, 293 (81%) patients completed their 30-day follow-up. Of these, 201 (69%) were admitted. There were 68 patients (23%) who had either a critical intervention or adverse outcome. The rule identified 66/68 patients who met the outcome for a sensitivity of 97% (95% confidence interval 93-100%) and specificity of 62% (56-69%). This pathway may be useful in identifying patients with syncope who are likely to have adverse outcome or critical interventions. Implementation and multicenter validation is needed before widespread application.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Shamai A
authors.initials: SA
authors.lastname: Grossman
authors.forename: Christopher
authors.initials: C
authors.lastname: Fischer
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mottley
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sands
authors.forename: Scott
authors.initials: S
authors.lastname: Thompson
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002985:Clinical Protocols; D015897:Comorbidity; D003661:Decision Support Techniques; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013575:Syncope / Q000150:complications / Q000453:epidemiology*