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

Abstract

Aims. EGSYS-U, EGSYS-M, and OESIL risk scores for syncope evaluation are introduced, evaluated retrospectively, and their ability to classify cardiac syncopes is compared. The specificity and sensitivity of the scores were analyzed. Guidelines for the practical application of the scoring systems are provided to reduce unnecessary hospital admissions.Methods. Retrospectively, 153 patients with syncope admitted to the Faculty Hospital in Ostrava in the year 2008 were enrolled for scoring with the EGSYS and OESIL risk scores. The computed scores were assessed with respect to the diagnosed etiology of the syncope.Results. For each score system, the hypothesis that there is no difference in the score between the cardiac and the non-cardiac group was rejected (all p-values below 0.0001). Strong correlation between the three score systems was shown (Spearman correlation coefficient: r = 0.71 p < 0.0001 for EGSYS-U and OESIL, r = 0.88 p < 0.0001 for EGSYS-U and EGSYS-M, r = 0.60 p < 0.0001 for EGSYS-M and OESIL). Sensitivity and specificity of the scores were computed and compared.Conclusions. All three score systems were found capable of classifying cardiac syncopes, reducing unnecessary hospital admissions and improving syncope risk evaluation. EGSYS-U was recommended for emergency syncope management because it was found to have both high sensitivity and high specificity.

Comparison of different risk stratification systems in predicting short-term serious outcome of syncope patients

“…reported the sensitivity and specificity of OESIL model in predicting syncope patient outcome as 93% and 54.6%, respectively. [24] In addition, Ebell estimated the sensitivity and specificity of San Francisco model to be 98% and 56%, respectively. [25] As can be seen, the findings of the studies are contradicting in this regard.…”

Validation of EGSYS Score in Prediction of Cardiogenic Syncope

“…The value of clinical findings and characteristics of syncope in prediction of patient outcomes have been evaluated in different studied [ 12 , 18 , 19 ]. In addition, various clinical decision rules have been designed and validated for this purpose [ 5 , 9 , 11 – 18 ]. Among them, EGSYS claims to be able to differentiate between cardiac causes and noncardiac causes of syncope.…”

“…Among them, EGSYS claims to be able to differentiate between cardiac causes and noncardiac causes of syncope. A study on 153 patients in 2008 showed that EGSYS is an efficient tool to distinguish cardiogenic syncope, reducing unnecessary hospitalization and improving ED management [ 18 ]. A study by Del Rosso et al in 2008 also demonstrated that EGSYS has high sensitivity in predicting cardiac causes of syncope [ 12 ].…”

“…Yet, in most countries, these units cannot be established and simpler strategies are used for triage of these patients. One of these strategies is using clinical risk stratification rules such as San Francisco syncope rule, short-term prognosis of syncope (STePS), and Evaluation of Guidelines in Syncope Study (EGSYS) [ 5 , 9 , 11 – 18 ]. Most of these models predict the patients' outcome, while EGSYS has been designed to differentiate between cardiac and noncardiac causes of syncope.…”

Syncope in children clinicoetiological correlation

“…28 Other study done by Plasek et al, states that EGSYS score >3 helps in prediction of cardiac etiology of cause of syncope. 29 There have not been many studies implementing this score in the emergency department for the identification of cardiac syncope. Comparing the correlation between severity and recurrence of syncope, 4 of patients with mild syncope had follow up repeat symptoms whereas 2 of pts with presyncope and 4 pts with severe syncope had follow up repeat symptoms.…”