NEW ORLEANS — A simple predictive instrument may improve emergency department disposition decisions regarding asymptomatic elderly patients who present with syncope.
The Syncope Risk Score defines a 10-fold gradient in the risk of delayed cardiac events among elderly ED patients with syncope, Dr. Benjamin Sun said at the annual meeting of the Society for Academic Emergency Medicine.
Patients whose score puts them in the low- or intermediate-risk categories may be reasonable candidates for discharge or a rapid ED observation unit. In contrast, those whose Syncope Risk Score places them in the high-risk group, with a 20% risk of a cardiac event during the next 30 days, probably should be admitted to the hospital, according to Dr. Sun of the University of California, Los Angeles.
The score relies upon one negative and six positive risk factors. All seven elements are readily obtainable in the first hour of an ED evaluation. A patient is assigned 1 point for each of the six factors conferring increased risk of delayed cardiac events, and minus 1 point for near syncope (see charts). The points are added up. A total score of 3-6 signifies high risk, 1-2 is intermediate, and 0 or −1 indicates low risk.
Dr. Sun developed the Syncope Risk Score through a retrospective cohort study of 2,871 asymptomatic geriatric patients, mean age 77 years, who visited any of three Southern California Kaiser Permanente EDs because of syncope and who did not have a serious underlying condition identified during their ED evaluation.
During the next 30 days, 170 patients experienced acute myocardial infarction, arrhythmia, coronary revascularization, or another delayed cardiac event. The seven independent predictors of these adverse outcomes that make up the Syncope Risk Score were derived via a multivariate logistic regression analysis that included more than 50 variables extracted from patients' medical charts.
The Syncope Risk Score is an attractively simple, quick tool, but before it is ready for prime-time clinical use in EDs it must be validated in an independent prospective study, Dr. Sun noted.
His development of the score was supported by the National Institutes of Health and the American Geriatrics Society.
Source ELSEVIER GLOBAL MEDICAL NEWS
Source ELSEVIER GLOBAL MEDICAL NEWS