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

Saeed Safari, Alireza Baratloo, Behrooz Hashemi, Farhad Rahmati, Mohammad Mehdi Forouzanfar, Maryam Motamedi, Ladan Mirmohseni


Background: Determining etiologic causes and prognosis can significantly improve management of syncope patients. The present study aimed to compare the values of San Francisco, Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL), Boston, and Risk Stratification of Syncope in the Emergency Department (ROSE) score clinical decision rules in predicting the short?term serious outcome of syncope patients. Materials and Methods: The present diagnostic accuracy study with 1?week follow?up was designed to evaluate the predictive values of the four mentioned clinical decision rules. Screening performance characteristics of each model in predicting mortality, myocardial infarction (MI), and cerebrovascular accidents (CVAs) were calculated and compared. To evaluate the value of each aforementioned model in predicting the outcome, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated and receiver?operating curve (ROC) curve  analysis was done. Results: A total of 187 patients (mean age: 64.2 ± 17.2 years) were enrolled in the study. Mortality, MI, and CVA were seen in 19 (10.2%), 12 (6.4%), and 36 (19.2%) patients, respectively. Area under the ROC curve for OESIL, San Francisco, Boston, and ROSE models in prediction the risk of 1?week mortality, MI, and CVA was in the 30–70% range, with no significant difference among models (P > 0.05). The pooled model did not show higher accuracy in prediction of mortality, MI, and CVA compared to others (P > 0.05). Conclusion: This study revealed the weakness of all four evaluated models in predicting short?term serious outcome of syncope patients referred to the emergency department without any significant advantage for one among others.

Key words: Decision support techniques, emergency service hospital, patient outcome assessment, syncope

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