Early standardized clinical judgement for syncope diagnosis in the emergency department

Lavallaz, Jeanne du Fay de; Badertscher, Patrick; Zimmermann, Tobias; Nestelberger, Thomas; Walter, Joan; Strebel, Ivo; Coelho, Campos; Miró, Òscar; Salgado, Emilio; Christ, Michael; Geigy, Nicolas; Cullen, Louise; Than, Martin; Martín‐Sánchez, Francisco Javier; Somma, Salvatore Di; Peacock, W. Frank; Morawiec, Beata; Wussler, Desiree; Keller, Dagmar I.; Gualandro, Danielle Menosi; Michou, Eleni; Kühne, Michael; Lohrmann, Jens; Reichlin, Tobias; Müeller, Christian; Flores, Dayana; Widmer, Velina; Breidthardt, Tobias; Mandrión, José Bustamante; Poepping, Imke; Kawecki, Damian; Muzyk, Piotr; Belkin, Maria; Puelacher, Christian; Lopez-Ayala, Pedro; Freese, Michael; Boeddinghaus, Jasper; Diebold, Matthias; Koechlin, Luca; Greenslade, Jaimi; Hawkins, Tracey; Rentsch, Katharina; Eckardstein, Arnold von; Buser, Andreas; Campodarve, Isabel; Gea, Joachim; Cruz, Helena Mañé; Calderón, S.; Inostroza, Carolina Isabel Fuenzalida; Briñón, Miguel Ángel García; Cadenas, María Suárez; Bingisser, Roland; Oßwald, Stefan

doi:10.1111/joim.13269

Cited by 6 publications

(11 citation statements)

References 29 publications

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“…When applied, either of these methods should speed the assessment time and make it much more accurate. Notably, in the Basel case, blood tests (troponin or brain natriuretic peptide) are included, and today these are quite widely available and add to precision (Thiruganasambandamoorthy et al, 2020a;du Fay de Lavallaz et al, 2021;Sutton, 2021).…”

Section: Introductionmentioning

confidence: 99%

Risk stratification of syncope: Current syncope guidelines and beyond

Sutton

Ricci

Fedorowski

2022

Autonomic Neuroscience

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Syncope is an alarming event carrying the possibility of serious outcomes, including sudden cardiac death (SCD). Therefore, immediate risk stratification should be applied whenever syncope occurs, especially in the Emergency Department, where most dramatic presentations occur. It has long been known that short-and long-term syncope prognosis is affected not only by its mechanism but also by presence of concomitant conditions, especially cardiovascular disease. Over the last two decades, several syncope prediction tools have been developed to refine patient stratification and triage patients who need expert in-hospital care from those who may receive nonurgent expert care in the community. However, despite promising results, prognostic tools for syncope remain challenging and often poorly effective.Current European Society of Cardiology syncope guidelines recommend an initial syncope workup based on detailed patient's history, physical examination supine and standing blood pressure, resting ECG, and laboratory tests, including cardiac biomarkers, where appropriate. Subsequent risk stratification based on screening of features aims to identify three groups: high-, intermediate-and low-risk. The first should immediately be hospitalized and appropriately investigated; intermediate group, with recurrent or medium-risk events, requires systematic evaluation by syncope experts; low-risk group, sporadic reflex syncope, merits education about its benign nature, and discharge. Thus, initial syncope risk stratification is crucial as it determines how and by whom syncope patients are managed. This review summarizes the crucial elements of syncope risk stratification, pros and cons of proposed risk evaluation scores, major challenges in initial syncope management, and how risk stratification impacts management of high-risk/recurrent syncope.

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Section: Introductionmentioning

confidence: 99%

Risk stratification of syncope: Current syncope guidelines and beyond

Sutton

Ricci

Fedorowski

2022

Autonomic Neuroscience

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“…The ESCJ offers a standardized approach to syncope assessment including a syncope specific case report form which accumulated in the correct identification of cardiac syncope with 87% accuracy. 37 The CSRS approach (table 3) uses a rapid risk stratification score to guide the management of patients when the cause of syncope had not been identified during initial evaluation. This tool includes pertinent features of the history, examination and investigations that are routinely collected within a trauma evaluation.…”

Section: Risk Stratificationmentioning

confidence: 99%

Trauma and syncope: looking beyond the injury

Kavi

Gall²

2023

Trauma Surg Acute Care Open

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Background42% of the population experience syncope by the age of 70, accounting for up to 6% of hospital admissions that frequently present as falls. The etiologies of some falls are benign, and others, such as cardiac syncope, are associated with a greater mortality and must be identified.MethodsThis review article aims to bridge the literature gap by providing a comprehensive practice review and critical summary of the current syncope guidance relating to the trauma patient.ResultsThe National Institute for Health and Care Excellence, the American College of Cardiology, and European Society of Cardiology published syncope risk stratification guidance. The inclusion of certain high-risk features represented in all three guidelines suggests their significance to identify cardiac syncope including heart failure, abnormal vital signs, syncope during exercise with little to no prodrome, family history of sudden cardiac death, and ECG abnormalities. Of 11 syncope risk stratification scoring systems based on these guidelines, only 2 are externally validated in the emergency department, neither of which are validated for major trauma use. Adherence to thorough history-taking, examination, orthostatic blood pressure recording, and an ECG can diagnose the cause of syncope in up to 50% of patients. ECG findings are 95% to 98% sensitive in the detection of serious adverse outcomes after cardiac syncope and should form part of a standardized syncope trauma assessment. Routine blood testing in trauma is often performed despite evidence that it is neither useful nor cost effective, where the screening of cardiac enzymes and D-dimer rarely influences management.DiscussionIn the absence of a gold-standard clinical test to identify the cause of a syncopal episode, standardized syncope guidelines as described in this review could be incorporated into trauma protocols to analyze high-risk etiologies, improve diagnostic accuracy, reduce unnecessary investigations, and develop an effective and safer management strategy.

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“…However, lack of reproducibility and remarkable heterogeneity in study design, variables, and outcome definitions of primary studies have prevented widespread use of these tools in clinical practice[ 92 ]. Moreover, recently some authors compared the EGSY score with clinical judgement, both alone and in addition to cardiac biomarkers, showing that clinical judgement has the highest diagnostic accuracy[ 93 ].…”

Section: Risk Stratificationmentioning

confidence: 99%

Arrhythmic syncope: From diagnosis to management

Pascual¹,

Marchite²,

Silva³

et al. 2023

World J Cardiol

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Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.

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Early standardized clinical judgement for syncope diagnosis in the emergency department

Cited by 6 publications

References 29 publications

Risk stratification of syncope: Current syncope guidelines and beyond

Risk stratification of syncope: Current syncope guidelines and beyond

Trauma and syncope: looking beyond the injury

Arrhythmic syncope: From diagnosis to management

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