Management of syncope referred urgently to general hospitals with and without syncope units

Abstract

Although only a minority of patients admitted as an emergency are referred to the syncope unit, overall management is substantially affected. It is speculated that the use of a standardized approach, such as that typically adopted in the syncope unit, is able to influence overall practice in the hospital.

The Egsys and Oesil Risk Scores for Classification of Cardiac Etiology of Syncope: Comparison, Revaluation, and Clinical Implications

“…In the Czech Republic, there are not enough fi nancial resources to establish and maintain SMUs which have been shown to be highly eff ective in initial syncope evaluation. In this study, we confi rmed the original results 3,6,10 that simple anamnestic data and ECG records organized in the form of a point score can help to recognize cardiac syncopes, which are considered to be the most dangerous 10 . From the three evaluated scores (EGSYS-U, EGSYS-M, and OESIL), we recommend that EGSYS-U be used in ED syncope management, because (at the appropriate cut-off level) it appears to have both high sensitivity and high specifi city.…”

“…The extension of syncope as a public health problem has been documented since the Framingham Study Report 2 showed the incidence of self-reported syncope to be 6.2 per 1000 person-years with a cumulative incidence of approximately 6% over 10 years. It has been reported [2][3][4][5][6] that syncope accounts for about 5% of Emergency Department (ED) visits and in the age group of patients older than 65, syncope becomes the sixth most common cause of hospitalization. Shen et al 5 report that in selected patient populations, the lifetime prevalence of syncope reaches almost 50%.…”

“…A SMU is a specialized unit in the Emergency Department (including its own staff) designated for syncope evaluation on a multidisciplinary basis, including telemetry monitoring, echocardiography, tilttable test and electrophysiological study equipment and risk prediction rules. The SMUs have been shown to be cost-effective and preserving high quality care, both in North American and European studies 3,5 . Unfortunately, establishing and maintaining SMUs is beyond the capacity of most community hospitals around the world (there is no SMU in the Czech Republic).…”

“…Several such rules were proposed recently, e.g. the OESIL risk score 6 , the EGSYS risk score 3 and the San Francisco Syncope Rule 8 . Surprisingly, the adherence to these easy syncope stratification methods seems to be low, possibly due to lack of leadership, lack of convincing data based on randomized clinical studies, and lack of a widely accepted standardized approach.…”

“…By means of uni-and multi-variate logistic regression, the most important independent predictors of a cardiac syncope were identified in a list of 52-item formulary. According to the value of the regression coefficient, positive or negative weights were associated to the respective predictors 3,9,10 . The OESIL score 6 is based on mortality data and it is designed to be as simple as possible (see Appendix 1).…”