Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score.
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.


METHODS
Prospective cohort study.


METHODS
ED of 14 general hospitals.


METHODS
516 consecutive patients with unexplained syncope.


METHODS
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.


METHODS
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 >or=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 >or=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.
Department of Cardiology, Azienda USL 11 Empoli, Italy. elettrofisiologia@usl11.tos.it
A
A
Del Rosso
A
A
Ungar
R
R
Maggi
F
F
Giada
N R
NR
Petix
T
T
De Santo
C
C
Menozzi
M
M
Brignole
D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology; D014218:Triage / Q000379:methods