New Assessment Tool Helps Determine If Syncope Cause Is Serious

October 3rd, 2016

OTTAWA, CANADA – Syncope makes up between 1% and 3% of all emergency department visits, and about 10% of those patients go on to experience an adverse event within a week or month of the visit, according to a recent study.

The dilemma for emergency medicine is determining when fainting is a symptom of a serious problem.

Now, a report published recently in the Canadian Medical Association Journal includes a simple nine-question tool to help emergency physicians determine if a hidden condition caused the fainting incident.

The Canadian Syncope Risk Score was created by researchers from The Ottawa Hospital and the University of Ottawa to help predict the risk of a patient experiencing an adverse event, such as potentially fatal irregular heart rhythm, heart attack and other cardiac events, gastrointestinal bleeding, and even death, within a month after fainting.

"Fainting is a big problem," explained Venkatesh Thiruganasambandamoorthy, MBBS, CCFP-EM, MSc. "The way fainting patients are examined in emergency rooms varies greatly between physicians and hospitals. We hope that this screening tool will make the process more consistent and improve the detection of serious conditions related to fainting."

For the study, the research team focused on 4,030 patients presenting with fainting at six Canadian hospitals. Of those, 147 patients experienced a serious event in the month following discharge.

Study authors identified eight factors that physicians can use to help determine future risk of an adverse event. Those are:

• the presumed cause of fainting at the end of emergency department assessment;
• whether fainting was triggered by the patient being in a warm or crowded place, standing for a long time, or experiencing intense fear, emotion, or pain;
• a history of heart disease;
• abnormal electrocardiogram measurements;
• high levels of troponin, a protein that indicates damage to the heart if detected in blood; and,
• abnormal blood pressure reading during the emergency visit.

Results indicate that the risk of a serious adverse event within 30 days ranged from 0.4% for a score of −3 to 83.6% for a score of 11.

“The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department,” study authors conclude. “Once validated, the tool will be able to accurately stratify the risk of serious adverse events among patients presenting with syncope, including those at low risk who can be discharged home quickly.”

"If our tool can discharge low-risk patients quickly and safely, then I think we can reduce emergency room wait times and open up those resources to other patients," Thiruganasambandamoorthy added.