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June 25, 2019JAMA

Clinical examination features, including age ≥35 years (LR 3.3; 95% CI 2.6-4.1) and history of atrial fibrillation (LR 7.3; 95% CI 2.4-22), accurately identify patients with cardiac syncope.

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Why the study?

Syncope can result from serious cardiac conditions or other causes, prompting a review of the accuracy of the clinical examination for identifying cardiac syncope.

Does the clinical examination accurately identify cardiac syncope in adults presenting with syncope?

Comparison

Clinical examination vs independent reference standard

Design

Systematic review

Key result

Clinical examination features, including age ≥35 years (LR 3.3; 95% CI 2.6-4.1) and history of atrial fibrillation (LR 7.3; 95% CI 2.4-22), accurately identify patients with cardiac syncope.

Authors

OAOmar T. AlbassamRRRobert J. RedelmeierSSSteven Shadowitz

Discussion

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Member takes

Overview

Age ≥35 years and AF history aid cardiac syncope identification at presentation; confirms accuracy of targeted clinical examination in syncope evaluation.

Study Design

Type

Systematic Review (n=4,317)

Structured PICO

Does the clinical examination accurately identify cardiac syncope in adults presenting with syncope?

P
Population
11 studies pooling 4,317 adults presenting to primary care, emergency departments, or referred to specialty clinics with syncope.
I
Intervention
Clinical examination (including history, physical examination, and multivariable scores like EGSYS)
C
Comparator
Independent comparison to a reference standard
O
Outcome
Diagnostic accuracy (sensitivity, specificity, and likelihood ratios) for identifying cardiac syncope

Specific clinical examination findings and multivariable scores like EGSYS can accurately help identify or rule out cardiac causes of syncope.

Limitations

  • Diagnostic thresholds for cardiac biomarkers require validation

Cite This Study

Albassam et al. (2019) conducted a systematic review in Cardiac syncope (n=4,317). Clinical examination vs. Reference standard was evaluated on Sensitivity, specificity, and likelihood ratios (LRs) for identifying cardiac syncope. Clinical examination features, including age ≥35 years (LR 3.3; 95% CI 2.6-4.1) and history of atrial fibrillation (LR 7.3; 95% CI 2.4-22), accurately identify patients with cardiac syncope.

synapsesocial.com/papers/6a1c2d4b1567d2fc4d5fb745https://doi.org/10.1001/jama.2019.8001
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Syncope and the heart: When to suspect and how to act?2026
  2. 2Evaluation of cardiac clues in patients admitted to pediatric cardiology outpatient clinic with syncope2024
  3. 3Syncope: Diagnostic Yield of Various Clinical Investigations2022 · 3 citations
  4. 4Is it cardiac? Assessment of syncope with a scoring system2008 · 3 citations
  5. 5Recent Updates and Technological Developments in Evaluating CardiacSyncope in the Emergency Department2022 · 1 citations