Martin et al identified factors for serious outcomes in a patient with syncope presenting to an Emergency Department. These can help identify a patient who may benefit from more aggressive management. The authors are from the University of Pittsburgh.
High risk outcomes within 1 year:
(1) cardiac arrhythmias (using a broad definition)
(2) death
Parameters:
(1) age
(2) ECG in the ED
(3) history of ventricular arrhythmias
(4) history of congestive heart failure (CHF)
Parameter |
Finding |
Points |
---|---|---|
age in years |
<= 45 years |
0 |
|
> 45 years |
1 |
ECG in the ED |
normal or nonspecific ST and T wave changes |
0 |
|
abnormal |
1 |
history of ventricular arrhythmias |
absent |
0 |
|
present |
1 |
history of CHF |
absent |
0 |
|
present |
1 |
where:
• Abnormal ECG changes include: atrial fibrillation, atrial flutter, multifocal atrial tachycardia, junctional or paced rhythms, ventricular tachycardia, premature ventricular contractions, bundle branch block, intraventricular conduction delay, AV heart block.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the greater the risk for a high risk outcome within 1 year.
Total Score |
Risk |
0 |
4-7% |
1 |
15% |
2 |
30-40% |
3 or 4 |
60-80% |
Purpose: To identify a patient in the Emergency Department (ED) with syncope who may be at increased risk for a serious outcome.
Specialty: Neurology
Objective: risk factors, severity, prognosis, stage
ICD-10: R55,