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.
Del Rosso
A
A
Department of Cardiology, Azienda USL 11 Empoli, Italy. elettrofisiologia@usl11.tos.it
Ungar
A
A
Maggi
R
R
Giada
F
F
Petix
N R
NR
De Santo
T
T
Menozzi
C
C
Brignole
M
M
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