Abstract 16740: Clinical Judgement Alone Challenges Evidence Based Clinical Predictive Rules When Diagnosing Cardiogenic Syncope
Clinicians vary in their ability to classify patients presenting with syncope into cardiogenic or high risk and vasovagal or low risk categories. Several clinical prediction rules (CPRs) have been developed to assist clinicians in the decision to admit patients who present with syncope or discharge them home from the Emergency Department (ED). We hypothesized that CJ is better at predicting cardiac etiology of syncope and short term adverse outcomes than CPRs (OESIL and EGSYS).
Between January 2012 and August 2012 and January 2013 to August 2013 we reviewed all adult patients that presented to the ED with chief complaint of syncope. Syncope was defined by the presence of transient loss of consciousness with spontaneous return to baseline. Patients were interviewed in the ED and followed up via a phone 10 days after the visit for the presence of adverse outcomes. Both CPRs were applied to each one of the subjects. For CJ, we considered patients admitted to telemetry as high risk for adverse event and cardiac syncope and patients discharged from the ED as low risk.
645 patients were screened, 135 met inclusion criteria and 3 were lost to follow up. The remaining 132 subjects were enrolled in the study. The OESIL score had a sensitivity 80 % specificity 40% PPV 24% and NPV 90% for adverse outcomes and a sensitivity 91 % specificity 40% PPV 13% and NPV 98% for cardiac etiology. EGSYS had a sensitivity 32%, specificity 73%, PPV 21% and NPV 82% for adverse outcome and a sensitivity 67%, specificity 53%, PPV 13% and NPV 94% for cardiac etiology. CJ had a sensitivity of 96%, specificity of 25%, PPV 23% and NPV 96 for adverse outcome and sensitivity of 91%, specificity of 32%, PPV 12% and NPV 97 for cardiac etiology.
In conclusion, the results suggest that none of the studied CPR offers sufficient accuracy to be used as sole instrument to risk stratify patients presenting with syncope to the ED. However, In comparison with CJ the OESIL score shows a better specificity while maintaining similar sensitivity to predict cardiogenic syncope. It would have decreased the number of admissions to telemetry by 6% without a difference in the number of missed events. Regarding adverse outcomes neither of the CPR offers an improved predictive ability as compared with CJ.
Author Disclosures: M. Iskandir: None. A. Nunez: None. H. Bhatt: None. K. Patel: None. S.R. Bahareh: None. D. Beshai: None. T. Bustros: None.
- © 2016 by American Heart Association, Inc.