Comparison of existing syncope rules and newly proposed anatolian syncope rule to predict short-term serious outcomes after syncope in the Turkish population

Abstract

BackgroundWe wished to compare the San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in Syncope Study (EGSYS) and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk scores and to assess their efficacy in recognising patients with syncope at high risk for short-term adverse events (death, the need for major therapeutic procedures, and early readmission to the hospital). We also wanted to test those variables to designate a local risk score, the Anatolian Syncope Rule (ASR).MethodsThis prospective, cohort study was conducted at the emergency department of a tertiary care centre. Between December 1 2009 and December 31 2010, we prospectively collected data on patients of ages 18 and over who presented to the emergency department with syncope.ResultsWe enrolled 231 patients to the study. A univariate analysis found 23 variables that predicted syncope with adverse events. Dyspnoea, orthostatic hypotension, precipitating cause of syncope, age over 58 years, congestive heart failure, and electrocardiogram abnormality (termed DO-PACE) were found to predict short-term serious outcomes by logistic regression analysis and these were used to compose the ASR. The sensitivity of ASR, OESIL, EGSYS and SFSR for mortality were 100% (0.66 to 1.00); 90% (0.54 to 0.99), 80% (0.44 to 0.97) and 100% (0.66 to 1.00), respectively. The specificity of ASR, OESIL, EGSYS and SFSR for mortality were 78% (0.72 to 0.83); 76% (0.70 to 0.82); 80% (0.74 to 0.85) and 70% (0.63 to 0.76). The sensitivity of ASR, OESIL, EGSYS and SFSR for any adverse event were 97% (0.85 to 1.00); 70% (0.52 to 0.82); 56% (0.40 to 0.72) and 87% (0.72 to 0.95). The specificity of ASR, OESIL, EGSYS and SFSR for any adverse event were 72% (0.64 to 0.78); 82% (0.76 to 0.87); 84% (0.78 to 0.89); 78% (0.71 to 0.83), respectively.ConclusionThe newly proposed ASR appears to be highly sensitive for identifying patients at risk for short-term serious outcomes, with scores at least as good as those provided by existing diagnostic rules, and it is easier to perform at the bedside within the Turkish population. If prospectively validated, it may offer a tool to aid physicians' decision-making.

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

“…In developing this guideline, the writing committee reviewed the evidence to support recommendations in the relevant ACC/AHA guidelines noted in Table 2 and affirms the ongoing validity of the related recommendations in the context of syncope, thus obviating the need to repeat existing guideline recommendations in 23 Expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope HRS 2015 24 Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death ESC 2015 and 2013 25,26 Expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease PACES/HRS 2014 27 Expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials HRS/ACC/AHA 2014 28 Expert consensus statement on ventricular arrhythmias EHRA/HRS/APHRS 2014 29 Expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes HRS/EHRA/APHRS 2013 25 Guidelines for the diagnosis and management of syncope ESC 2009 30 e66 Syncope A symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone, with rapid and spontaneous recovery. The presumed mechanism is cerebral hypoperfusion.…”

Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope

“…The Boston Syncope Criteria comprise a long list of 25 plausible predictors for 30-day serious adverse events without mathematical modelling. 8 Kayayurt and colleagues 26 published the Anatolian Syncope Rule, but it was developed from a small sample of 231 Turkish patients with 39 serious adverse events. Three of the studies 13,14,26 included readmission to hospital without identification of serious underlying conditions as an outcome.…”

“…8 Kayayurt and colleagues 26 published the Anatolian Syncope Rule, but it was developed from a small sample of 231 Turkish patients with 39 serious adverse events. Three of the studies 13,14,26 included readmission to hospital without identification of serious underlying conditions as an outcome. All of the studies except 2 14,26 included cortical stroke as an outcome and patients with obvious serious adverse events identified in the emergency department for derivation of the prediction tool.…”

“…Three of the studies 13,14,26 included readmission to hospital without identification of serious underlying conditions as an outcome. All of the studies except 2 14,26 included cortical stroke as an outcome and patients with obvious serious adverse events identified in the emergency department for derivation of the prediction tool. Because cortical strokes are not related to global hypoperfusion, the European Society of Cardiology recommended that they not be included as a serious adverse event.…”

“…8,9,13,14,26 The San Francisco Syncope Rule was developed to predict such outcomes within 7 days. 13 It performed poorly on external validation at various study sites, which made it unacceptable for adoption into practice.…”