Early standardized clinical judgement for syncope diagnosis in the emergency department. (23rd March 2021)

• Record Type: Journal Article
• Authors: du Fay de Lavallaz, J.; Badertscher, P.; Zimmermann, T.; Nestelberger, T.; Walter, J.; Strebel, I.; Coelho, C.; Miró, Ò.; Salgado, E.; Christ, M.; Geigy, N.; Cullen, L.; Than, M.; Javier Martin‐Sanchez, F.; Di Somma, S.; Frank Peacock, W.; Morawiec, B.; Wussler, D.; Keller, D. I.; Gualandro, D.; Michou, E.; Kühne, M.; Lohrmann, J.; Reichlin, T.; Mueller, C.
• Other Names: Flores Dayana investigator.; Widmer Velina investigator.; Breidthardt Tobias investigator.; Bustamante Mandrión José investigator.; Poepping Imke investigator.; Kawecki Damian investigator.; Muzyk Piotr investigator.; Belkin Maria investigator.; Puelacher Christian investigator.; Lopez Ayala Pedro investigator.; Freese Michael investigator.; Boeddinghaus Jasper investigator.; Diebold Matthias investigator.; Koechlin Luca investigator.; Greenslade Jaimi investigator.; Hawkins Tracey investigator.; Rentsch Katharina investigator.; von Eckardstein Arnold investigator.; Buser Andreas investigator.; Campodarve Isabel investigator.; Gea Joachim investigator.; Cruz Helena Mañé investigator.; Calderon Sofìa investigator.; Fuenzalida Inostroza Carolina Isabel investigator.; Briñón Miguel Angel García investigator.; Suárez Cadenas María investigator.; Bingisser Roland investigator.; Osswald Stefan investigator.
• Is Part Of: Journal of internal medicine. Volume 290:Number 3(2021)
• Page Start: 728
• Page End: 739
• Publication Date: 2021-03-23
• Subjects: syncope -- early clinical judgement -- diagnosis -- emergency department -- risk‐stratification; Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.13269
• Languages: English
• ISSNs: 0954-6820

Abstract

Abstract: Background: The diagnosis of cardiac syncope remains a challenge in the emergency department (ED). Objective: Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope‐specific case report form (CRF) in comparison with a recommended multivariable diagnostic score. Methods: In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1‐year follow‐up. Secondary aims included direct comparison with high‐sensitivity cardiac troponin I (hs‐cTnI) and B‐type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ. Results: Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84–0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70–0.76)), hs‐cTnI (0.77 (95% CI: 0.73–0.80)) and BNP (0.77 (95% CI: 0.74–0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy. Conclusion: ESCJ including a standardized syncope‐specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs‐cTnI and BNP. Abstract :