Current issues with prediction rules for syncope

Syncope Prediction Scores in the Emergency Department

“…A systematic review and meta-analysis proceeded to evaluate the accuracy of the SFSR in 2011 [ 22 ], indicating that the SFSR was unsatisfactory. Serrano et al [ 5 ] suggested differences in study design and ECG interpretation may account for the variable prognostic performance of the SFSR when validated in different practice settings.…”

Syncope

“…They summarized each false-negative outcome noting that 47% of the missed serious outcomes were supraventricular tachycardia, ventricular tachycardia, or undefined arrhythmias. 10,16,74,78 The largest prospective cohort study of the SFSR score was performed as a multicenter Asian study that showed a slightly worse sensitivity than previous reports (94% compared to the previous 96% and 98%) and generated the caveat that the score should only be used as an aid to clinical judgment when the etiology of syncope is unclear. 75 Other studies have shown that risk scores fare no better than clinical judgment.…”

“…75 Other studies have shown that risk scores fare no better than clinical judgment. 24,40,78,79 Sule and colleagues evaluated both the OESIL and SFSR risk scores and found that the scores were poor predictors of long-term (>3 months) adverse events or hospitalization. 28 Prognostication of both short-term and longer term events in syncope is largely an art and complete reliance on risk scores is not recommended; the scores are generally regarded as tools used for screening after a proper and focused initial workup has been completed and no etiology has been found.…”

“…28 Prognostication of both short-term and longer term events in syncope is largely an art and complete reliance on risk scores is not recommended; the scores are generally regarded as tools used for screening after a proper and focused initial workup has been completed and no etiology has been found. 16,75,78,80 When to Admit the Patient With Syncope to the Hospital…”