Why the study?
Treatment of syncope in older adults places a burden on healthcare systems, motivating the evaluation of risk stratification tools to predict short-term adverse outcomes.
What is the predictive performance of five risk stratification tools (ROSE, SFSR, FAINT, CSRS, BSC) for short-term adverse outcomes in older adults presenting with syncope?
What is the predictive performance of five risk stratification tools (ROSE, SFSR, FAINT, CSRS, BSC) for short-term adverse outcomes in older adults presenting with syncope?
Multiple syncope risk stratification tools demonstrate varying trade-offs between sensitivity and specificity, with the Boston Syncope Criteria offering the highest sensitivity and negative predictive value for older adults in the emergency department.
BSC may aid ruling out short-term events in older syncope patients; leaves open optimal tool selection without prospective validation.
OBJECTIVE: Treatment of syncope in older adults places a burden on healthcare systems. We used five risk stratification tools to predict short-term adverse outcomes in older patients with syncope. METHODS: This was a retrospective analysis of patients with syncope (age ≥60 years) in the emergency department of an urban academic hospital. The data were evaluated using the Risk Stratification of Syncope in the Emergency Department (ROSE), San Francisco Syncope Rule (SFSR), FAINT, Canadian Syncope Risk Score (CSRS), and Boston Syncope Criteria (BSC) tools. Sensitivity, specificity, accuracy, positive and negative predictive value (NPV), and positive and negative likelihood ratios of each tool were calculated and compared for adverse events within 1 month. RESULTS: In total, 221 patients (average age 75.6 years) were analyzed. Fifty-nine patients (26.7%) had experienced an adverse event within 1 month. For the ROSE, SFSR, FAINT, CSRS and BSC tools, sensitivities were 81.3%, 76.3%, 93.2%, 71.2%, and 94.9%, specificities were 88.3%, 87.7%, 56.8%, 71.6%, and 67.3%, and NPVs were 92.9%, 91.0%, 95.8%, 87.2%, and 97.3%, respectively. CONCLUSION: The five assessed tools could be useful for physicians in screening older patients with syncope for the risk of short-term adverse events, according to the patient's actual situation.
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Mu et al. (2024) studied this question.
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