Usefulness of syncope guidelines in risk stratification of syncope in emergency department

Abstract

Background: Management of patients with syncope in the Emergency Department now focuses on identifying patients who will be at future risk of serious morbidity. Among the risk stratification scoring systems being used were the San Francisco Syncope Rule (SFSR) and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score. Objective: To assess the accuracy of SFSR and OESIL score at predicting short-term serious outcome in Maharaj Nakorn Chiang Mai Hospital. Material and Method: In a prospective descriptive analysis study, adult patients presenting with syncope or near syncope between October 1, 2009 and April 24, 2010 were enrolled. All patients were followed-up at 7-day and 1-month. Statistical analysis included accuracy, sensitivity, specificity, predictive values, and likelihood ratios. Results: One hundred seventy eight patients were enrolled in the present study. Fifty-three patients had a short-term serious outcome on follow-up. SFSR had 74.7% accuracy, 90.6% sensitivity, 68% specificity, 54.5% PPV, 94.4% NPV, likelihood ratio positive (LR+) of 2.8, and likelihood ratio negative (LR-) of 0.1, whereas OESIL score had 80.9% accuracy, 79.4% sensitivity, 81.6% specificity, 64.6% PPV, 90.3% NPV, LR+ of 4.3, and LR- of 0.2. Conclusion: Both scores have good accuracy and sensitivity, but they should not be used as the only device in patient disposition. However, both scores showed a low false negative rate. Therefore, they may help in helping physician discharge low-risk patients.