Background: Various scores have been derived for the assessment of syncope patients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS2 score. Methods: We prospectively enrolled patients ≥ 40 years old presenting with syncope to the ED in a multicenter study. Early clinical judgment (ECJ) of the treating ED-physician regarding the probability of cardiac syncope was quantified. Two independent physicians adjudicated the final diagnosis after 1-year follow-up. Major cardiovascular events (MACE) and death were recorded during 2 years of follow-up. Nine scores were compared by their area under the receiver-operator characteristics curve (AUC) for death, MACE or the diagnosis of cardiac syncope. Results: 1490 patients were available for score validation. The CHADS2-score presented a higher or equally high accuracy for death in the long- and short-term follow-up than other syncope-specific risk scores. This score also performed well for the prediction of MACE in the long- and short-term evaluation and stratified patients with accuracy comparative to OESIL, one of the best performing syncope-specific risk score. All scores performed poorly for diagnosing cardiac syncope when compared to the ECJ. Conclusions: The CHADS2-score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncope patients. While better tools incorporating biochemical and electrocardiographic markers are needed, this study suggests that the CHADS2-score is currently a good option to stratify risk in syncope patients in the ED. Trial registration: NCT01548352
Prospective validation of prognostic and diagnostic syncope scores in the emergency department / du Fay de Lavallaz, Jeanne; Badertscher, Patrick; Nestelberger, Thomas; Isenrich, Rahel; Miró, Òscar; Salgado, Emilio; Geigy, Nicolas; Christ, Michael; Cullen, Louise; Than, Martin; Martin-Sanchez, F. Javier; Bustamante Mandrión, José; Di Somma, Salvatore; Peacock, W. Frank; Kawecki, Damian; Boeddinghaus, Jasper; Twerenbold, Raphael; Puelacher, Christian; Wussler, Desiree; Strebel, Ivo; Keller, Dagmar I.; Poepping, Imke; Kühne, Michael; Mueller, Christian; Reichlin, Tobias; Giménez, Maria Rubini; Walter, Joan; Kozhuharov, Nikola; Shrestha, Samyut; Mueller, Deborah; Sazgary, Lorraine; Morawiec, Beata; Muzyk, Piotr; Nowalany-Kozielska, Ewa; Freese, Michael; Stelzig, Claudia; Meissner, Kathrin; Kulangara, Caroline; Hartmann, Beate; Ferel, Ina; Sabti, Zaid; Greenslade, Jaimi; Hawkins, Tracey; Rentsch, Katharina; von Eckardstein, Arnold; Buser, Andreas; Kloos, Wanda; Lohrmann, Jens; Osswald, Stefan. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 269:Oct 15(2018), pp. 114-121. [10.1016/j.ijcard.2018.06.088]
Prospective validation of prognostic and diagnostic syncope scores in the emergency department
Di Somma, SalvatoreWriting – Review & Editing
;
2018
Abstract
Background: Various scores have been derived for the assessment of syncope patients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS2 score. Methods: We prospectively enrolled patients ≥ 40 years old presenting with syncope to the ED in a multicenter study. Early clinical judgment (ECJ) of the treating ED-physician regarding the probability of cardiac syncope was quantified. Two independent physicians adjudicated the final diagnosis after 1-year follow-up. Major cardiovascular events (MACE) and death were recorded during 2 years of follow-up. Nine scores were compared by their area under the receiver-operator characteristics curve (AUC) for death, MACE or the diagnosis of cardiac syncope. Results: 1490 patients were available for score validation. The CHADS2-score presented a higher or equally high accuracy for death in the long- and short-term follow-up than other syncope-specific risk scores. This score also performed well for the prediction of MACE in the long- and short-term evaluation and stratified patients with accuracy comparative to OESIL, one of the best performing syncope-specific risk score. All scores performed poorly for diagnosing cardiac syncope when compared to the ECJ. Conclusions: The CHADS2-score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncope patients. While better tools incorporating biochemical and electrocardiographic markers are needed, this study suggests that the CHADS2-score is currently a good option to stratify risk in syncope patients in the ED. Trial registration: NCT01548352File | Dimensione | Formato | |
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