title: Prognostic value of the OESIL risk score in a cohort of Emergency Department patients with syncope.
abstract: OBJECTIVE
  The aim of this paper was to assess short and long term prognostic value of the OESIL risk score (ORS), a risk stratification rule for syncope which consider abnormal ECG, age > 65, history of cardiovascular diseases, lack of prodromal symptoms to identify patients at higher risk of mortality (ORS≥2) to be admitted.
  
  
  METHODS
  This is a prospective cohort study in which syncopal recurrences, readmission for other reasons, major therapeutic procedures, cardiovascular events, death for any reason, were assessed in a group of 200 syncopal patients at both 1 month and 1 year after discharge from an Emergency Department Observation Unit.
  
  
  RESULTS
  Multinomial logistic regression analysis showed that ORS ≥2 is not associated with any endpoint, except major procedures. Conversely, ORS≥3 was a strong predictor of at least 1 adverse event within 1 month and severe outcomes within 1 year, particularly for non-syncopal readmission (P<0.005), major procedures (P<0.002), cardiovascular events (P<0.023), and death for any cause (P<0.022).
  
  
  CONCLUSIONS
  Our patient group was significantly older than the ORS derivation cohort (72.4±15.1 vs. 59.5±24.3 yrs) and mostly above the age considered as 1 point in the ORS, so it is rather understandable that only a more restrictive cut-off might be advantageous for identifying high risk patients. On the evidence of a progressive ageing of patients presenting at the EDs, we suggest to use a ³3 ORS threshold when deciding for admission.
authors.affiliation: Emergency Department, University Hospital of Parma, Parma, Italy - fnumeroso@ao.pr.it.
authors.forename: F
authors.initials: F
authors.lastname: Numeroso
authors.forename: G
authors.initials: G
authors.lastname: Mossini
authors.forename: F
authors.initials: F
authors.lastname: Montali
authors.forename: G
authors.initials: G
authors.lastname: Lippi
authors.forename: G
authors.initials: G
authors.lastname: Cervellin
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D003661:Decision Support Techniques; D004630:Emergencies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012016:Reference Values; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013575:Syncope / Q000209:etiology / Q000401:mortality / Q000628:therapy; D014218:Triage