Sun et al developed a simple risk score for identifying an older person with syncope who may have a serious event within 30 days. The authors are from the University of California Los Angeles, the West Los Angeles Veterans Affairs Medical Center, and Kaiser Permanente-Southern California.
Patient selection: age >= 60 years with syncope or near syncope
Serious outcomes included: death, significant cardiac arrhythmias, myocardial infarction, pulmonary embolism, new structural defect in the heart, aortic dissection, stroke, transient ischemic attack (TIA), cerebral hemorrhage, and need for blood transfusion (due to hemorrhage or anemia).
Parameters:
(1) age
(2) gender
(3) history of cardiac arrhythmias
(4) systolic blood pressure in mm Hg at triage
(5) electrocardiogram (ECG)
(6) serum troponin I
(7) event (syncope vs near syncope)
|
Parameter
|
Finding
|
Points
|
|
age
|
<= 90 years
|
0
|
|
|
> 90 years
|
1
|
|
gender
|
female
|
0
|
|
|
male
|
1
|
|
history of cardiac arrhythmias
|
no
|
0
|
|
|
yes
|
1
|
|
systolic blood pressure
|
<= 160 mm Hg
|
0
|
|
|
> 160 mm Hg
|
1
|
|
ECG
|
normal
|
0
|
|
|
abnormal
|
1
|
|
serum troponin
|
normal
|
0
|
|
|
elevated
|
1
|
|
event
|
syncope
|
0
|
|
|
near syncope
|
-1
|
where:
• The score could just as easily have been done scoring syncope as 1 point and near syncope as 0 points.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -1
• maximum score: 6
• The higher the score the greater the risk for a serious outcome.
|
Total Score
|
Risk Group
|
30-Day Risk of a Serious Event
|
|
-1 or 0
|
low
|
2.5%
|
|
1 or 2
|
intermediate
|
6.3%
|
|
3 to 6
|
high
|
20%
|
