Risk prediction tools for Syncope: The quest for the holy grail

Syncope may be a presenting symptom for several conditions ranging from benign illnesses to various life- threatening conditions such as ventricular arrhythmias. Syncope accounts for 0.8% to 2.4% of all emergency department (ED) visits, and up to 6% of inpatient admissions [ [1] Shen W.-K. Sheldon R.S. Benditt D.G. et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients With syncope: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. J. Am. Coll. Cardiol. 2017; 70: e39-e110 Crossref PubMed Scopus (157) Google Scholar ]. Evaluation of a patient with syncope may be challenging, and involve a large panel of diagnostic tests with significant health care costs. Sometimes, it may not be possible to identify a definitive etiology for syncope even after a thorough assessment. Alternatively, patients may have several equally probable causes of syncope. A number of risk prediction scores have been published to identify high-risk patients over short-term (up to 30 days) and long-term (up to 12 months) follow-up. The scores that have been studied include the San Francisco Syncope Rule (SFSR) score, Risk stratification Of Syncope in the Emergency department (ROSE) rule, Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score, the Boston Syncope score, the Short-Term Prognosis of Syncope (STePS) score for long- and short-term risk prediction, the Evaluation of Guidelines in SYncope Study (EGSYS) score, and the risk score described by Martin et al. [ 2 Quinn J.V. Stiell I.G. McDermott D.A. Sellers K.L. Kohn M.A. Wells G.A. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann. Emerg. Med. 2004; 43: 224-232 Abstract Full Text Full Text PDF PubMed Scopus (319) Google Scholar , 3 Reed M.J. Newby D.E. Coull A.J. Prescott R.J. Jacques K.G. Gray A.J. The ROSE (Risk Stratification of Syncope in the Emergency Department) Study. J. Am. Coll. Cardiol. 2010; 55: 713-721 Crossref PubMed Scopus (203) Google Scholar , 4 Colivicchi F. Ammirati F. Melina D. Guido V. Imperoli G. Santini M. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur. Heart J. 2003; 24: 811-819 Crossref PubMed Scopus (298) Google Scholar , 5 Shamai A. Grossman Fischer C. Lipsitz L.A. et al. Predicting adverse outcomes in Syncope. J. Emerg. Med. 2007; 33: 233-239 Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar , 6 Costantino G. Perego F. Dipaola F. et al. Short- and long-term prognosis of Syncope, risk factors, and role of hospital admission. Results from the STePS (Short-Term Prognosis of Syncope) Study. J. Am. Coll. Cardiol. 2008; 51: 276-283 Crossref PubMed Scopus (206) Google Scholar , 7 Del Rosso A. Ungar A. Maggi R. et al. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score. Heart. 2008; 94: 1620-1626 Crossref PubMed Scopus (254) Google Scholar , 8 Martin T.P. Hanusa B.H. Kapoor W.N. Risk stratification of patients with Syncope. Ann. Emerg. Med. 1997; 29: 459-466 Abstract Full Text Full Text PDF PubMed Scopus (244) Google Scholar ] None of these scores have been widely adopted due to various reasons including complexity of use, limited external validation, lack of solid endpoints, and paucity of data showing improved clinical outcomes. Prospective validation of prognostic and diagnostic syncope scores in the emergency departmentInternational Journal of CardiologyVol. 269PreviewVarious 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. Full-Text PDF