Syncope management in the UK and Republic of Ireland

Stockley, C J; Bonney, Megan; Gray, Alasdair; Reed, Matthew J

doi:10.1136/emj.2008.062281

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…Here we have extended these observations to a broad group of patients presenting with syncope and have demonstrated that it is the single most powerful predictor of adverse outcome, particularly death. Although in the United Kingdom only 5% of EDs currently have point-of-care BNP testing (25), 44% have point-ofcare testing facilities (25) and almost all have rapid access to laboratory BNP, because of National Institute of Health and Clinical Excellence recommendations (26).…”

Section: Discussionmentioning

confidence: 99%

The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

Reed

Newby

Coull

et al. 2010

Journal of the American College of Cardiology

239

176

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The ROSE rule has excellent sensitivity and negative predictive value in the identification of high-risk patients with syncope. As a component, BNP seems to be a major predictor of serious cardiovascular outcomes and all-cause death. The ROSE rule and BNP measurement might be valuable risk stratification tools in patients with emergency presentations of syncope and should now be subjected to external validation.

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Section: Discussionmentioning

confidence: 99%

The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

Reed

Newby

Coull

et al. 2010

Journal of the American College of Cardiology

239

176

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show abstract

“…The management of syncope in the emergency department varies greatly among physicians and centres, 37 although several evidencebased recommendations have been published in recent years. [38][39][40] Therefore, the population of patients without an evident cause of syncope may vary considerably according to the practices of local emergency departments, and judgment for generalization of the San Francisco Syncope Rule in this population remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review

Saccilotto

Nickel²,

Bucher³

et al. 2011

CMAJ

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Background:The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been valid ated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes. Methods:We identified studies by means of systematic searches in seven electronic databases from inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics. Results:We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79-0.93), and the pooled estimate of specificity was 0.52 (95% CI 0.43-0.62). There was substantial between-study heterogeneity (resulting in a 95% prediction interval for sensitivity of 0.55-0.98). The probability of a serious outcome given a negative score with the San Francisco Syncope Rule was 5% or lower, and the probability was 2% or lower when the rule was applied only to patients for whom no cause of syncope was identified after initial evaluation in the emergency department. The most common cause of false-negative classification for a serious outcome was cardiac arrhythmia. Interpretation:The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after in itial evaluation in the emergency department. Consideration of all available electrocardiograms, as well as arrhythmia monitoring, should be included in application of the San Francisco Syncope Rule. Between-study hetero geneity was likely due to inconsistent classification of arrhythmia. AbstractSee related commentary by Parry at www.cmaj.ca/lookup

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“…The current use of observation wards and syncope clinical decision units is not widespread; for example only 27% of UK EDs have an observation ward that admits syncope patients. [18] The new ESC syncope guidelines promote the use of syncope clinical decision units within the ED. They allow a period of ECG monitoring for patients thought to be at risk of arrhythmic syncope and selected echocardiography if structural or valvular heart disease, or heart failure, is suspected.…”

Section: Should My Hospital Have a Syncope Clinical Decision Unit?mentioning

confidence: 99%

“…The current use of specialist syncope outpatient clinic is also not widespread; for example only 18% of UK EDs have access to a specialist syncope outpatient clinic. [18] The new ESC syncope guidelines promote the use of rapid access syncope clinics as a safe way to reduce admissions and ensure patients receive timely, focused expert opinion and investigation. Setting up a syncope rapid access syncope clinic in your hospital requires a multidisciplinary team approach, including emergency medicine, acute medicine, care of the elderly, neurology, cardiology, electrophysiology, nursing, cardiac imaging and neurophysiology, keen enthusiasts (a syncope site champion) and a lot of energy.…”

Section: Should My Hospital Have a Syncope Clinical Decision Unit?mentioning

confidence: 99%

Managing Syncope/Collapse in the Emergency Department

Reed

2020

Syncope

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Statement of any Conflict of interest: MR has been supplied with Zio XT monitors and ECG analysis services free of charge for research purposes from iRhythm Technologies between 2015 and 2017. MR has received funds for consultation from Medtronic Inc in 2018. MR was a Task Force member for the diagnosis and management of syncope of the European Society of Cardiology (ESC) published in March 2018. The Emergency Medicine Research Group Edinburgh has received sponsorship for the EMERGE10 conference in 2018 from various companies including Medtronic Inc, AliveCor and iRhythm Technologies. MR is supported by an NHS Research Scotland Career Researcher Clinician award.

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Syncope management in the UK and Republic of Ireland

Abstract: The ED management of syncope patients in the UK and Republic of Ireland is varied. Only 18% of ED have specific guidelines for managing this difficult condition and only 18% have access to a specialist syncope clinic. A robust consensus UK syncope guideline is clearly required.

Cited by 8 publications

References 17 publications

The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review

Managing Syncope/Collapse in the Emergency Department

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