Canadian Syncope Risk Score - In case of syncope, patients are really in danger or not?

The Canadian Syncope Risk Score was studied to understand if syncope is about to occur. It is a questionnaire which has been projected by the Ottawa Hospital Research Institute and published on the Canadian Medical Association Journal. 

This questionnaire represents a kind of screening test which will help GPs and ER physicians to understand if a patient who suffers a syncope deserves to be hospitalized or not, i.e. to understand the dangerousness of a syncope. It is the Canadian Syncope Risk Score, by the Ottawa Hospital Research Institute and the University of Ottawa.

This will probably turn out to be an efficient method to know how to treat patients and avoiding queues at the ER. Syncope can be caused by serious conditions not evident during the initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department. Researchers sought to develop a clinical decision tool to identify adult patients with syncope who are at risk of a serious adverse event within 30 days after disposition from the emergency department.

The methods of the Canadian Syncope Risk Score

Researchers prospectively enrolled adults (age ≥ 16 yr) with syncope who presented within 24 hours after the event to 1 of 6 large emergency departments from Sept. 29, 2010, to Feb. 27, 2014. They collected standardized variables at index presentation from clinical evaluation and investigations. Adjudicated serious adverse events included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, serious haemorrhage and procedural interventions within 30 days.

 

Canadian Syncope Risk Score, the results

They enrolled 4030 patients with syncope; the mean age was 53.6 years, 55.5% were women, and 9.5% were admitted to hospital. Serious adverse events occurred in 147 (3.6%) of the patients within 30 days after disposition from the emergency department. Of 43 candidate predictors examined, they included 9 in the final model: predisposition to vasovagal syncope, heart disease, any systolic pressure reading in the emergency department < 90 or > 180 mm Hg, troponin level above 99th percentile for the normal population, abnormal QRS axis (< −30° or > 100°), QRS duration longer than 130 ms, QTc interval longer than 480 ms, emergency department diagnosis of cardiac syncope and emergency department diagnosis of vasovagal syncope (C statistic 0.88, 95% confidence interval [CI] 0.85–0.90; optimism 0.015; goodness-of-fit p = 0.11). The risk of a serious adverse event within 30 days ranged from 0.4% for a score of −3 to 83.6% for a score of 11. The sensitivity was 99.2% (95% CI 95.9%–100%) for a threshold score of −2 or higher and 97.7% (95% CI 93.5%–99.5%) for a threshold score of −1 or higher.

More details on the study and the authors at the end of the article.

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SOURCE

Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope

 

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