Del Rosso et al developed a score for identifying a patient who may have cardiac syncope. This can help to guide patient evaluation and management. The authors are from multiple hospitals in Italy participating in the EGSYS-2 (Evaluation of Guidelines in SYncope Study 2) trial.
Patient selection: syncope
Parameters:
(1) palpitations before syncope
(2) history of heart disease and/or abnormal ECG
(3) syncope during effort
(4) syncope while supine
(5) precipitating and/or predisposing factors (warm or crowded place, prolonged orthostasis, fear, pain, emotion)
(6) autonomic prodrome (nausea, vomiting, other)
|
Parameter |
Finding |
Points |
|
palpitations before syncope |
no |
0 |
|
|
yes |
4 |
|
history of heart disease and/or abnormal ECG |
no |
0 |
|
|
yes |
3 |
|
syncope during effort |
no |
0 |
|
|
yes |
3 |
|
syncope while supine |
no |
0 |
|
|
yes |
2 |
|
precipitating and/or predisposing factors |
no |
0 |
|
|
yes |
-1 |
|
autonomic prodrome |
no |
0 |
|
|
yes |
-1 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -2
• maximum score: 12
• A score >= 3 identifies a patient who has a high risk for having cardiac syncope.
• Patients identified with cardiac syncope had a higher total mortality than those with other forms of syncope.
Performance:
• The area under the ROC curve was 0.90 for the derivation and 0.85 for the validation cohorts.
• Using a score >= 3 had a sensitivity of 92-95% and specificity of 61-69%.
Specialty: Neurology
