The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

Reed, Matthew J; Newby, David E.; Coull, Andrew; Prescott, R. J.; Jacques, Keith G; Gray, Alasdair

doi:10.1016/j.jacc.2009.09.049

Cited by 241 publications

(186 citation statements)

References 29 publications

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“…[5][6][7] In contrast, other investigators 8 assumed that syncope and near syncope were identical. To answer this question, Grossman and colleagues 4 compared the clinical outcome of patients with presyncope with that of individuals with syncope and found no difference.…”

Section: Determine How To Manage Patients Presenting With Near Syncopmentioning

confidence: 99%

“…5,7,8,10,11 The primary goal of the ED physician is thus to discriminate individuals at low risk who can be safely discharged, from patients at high risk who require prompt hospitalization for monitoring and/or appropriate treatment.…”

Section: The Second Step: Ruling Out Causes Of Syncope That May Lead mentioning

confidence: 99%

“…Examples of such rules are the risk stratification of syncope in the emergency department (Rose), San Francisco Syncope Rule (SFSR), and Boston Syncope Rules, 7,8,15 with the SFSR 8 being the only rules that are externally validated.…”

Section: Rulesmentioning

confidence: 99%

“…7 Reed and colleagues 7 recruited 550 patients for deriving and 550 individuals for validating the rule and observed that the presence of at least 1 of the proposed variables (risk factors) had a sensitivity of 87% and a specificity of 66% for adverse events (see Tables 1-3). Adverse events included acute myocardial infarction, lifethreatening arrhythmias (ventricular fibrillation, sustained, ventricular tachycardia, ventricular pause >3 seconds), pacemaker or cardiac defibrillator implant within 1 month from the index syncope, pulmonary embolism, cerebrovascular accidents, intracranial or subarachnoid hemorrhage, hemorrhage requiring more than 2 units of blood transfusion, acute surgical procedures, or endoscopic intervention (see Table 2).…”

Section: The Rose Rulementioning

confidence: 99%

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Syncope Risk Stratification in the Emergency Department

Costantino

Furlan

2013

Cardiology Clinics

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An 89-year-old What steps should be taken to deal with a patient presenting at the ED because of a transient loss of consciousness? THE FIRST STEP: IDENTIFYING PATIENTS WITH SYNCOPETo identify the patient with syncope, 3 major issues have to be addressed:Distinguish patients with syncope from those with a transient loss of consciousness (T-LoC) of nonsyncopal origin Differentiate patients with syncope from those having falls Determine how to manage patients presenting with near syncopeThe authors have nothing to disclose.

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Section: Determine How To Manage Patients Presenting With Near Syncopmentioning

confidence: 99%

Section: The Second Step: Ruling Out Causes Of Syncope That May Lead mentioning

confidence: 99%

Section: Rulesmentioning

confidence: 99%

Section: The Rose Rulementioning

confidence: 99%

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Syncope Risk Stratification in the Emergency Department

Costantino

Furlan

2013

Cardiology Clinics

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“…Among ED syncope patients, 7 to 23% will suffer a serious adverse event (SAE) within 7 to 30 days of their visit. [2][3][4][5][6][7][8][9][10] These include death, arrhythmia, myocardial infarction, diagnosis of serious underlying structural heart disease, or procedural interventions to treat the cause of the syncopal event.…”

Section: Ré Sumémentioning

confidence: 99%

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Thiruganasambandamoorthy

Wells

Hess

et al. 2014

CJEM

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Background: Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days. Methods: We conducted a medical record review to include syncope patients age $ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed. Results: Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age $ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure , 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen . 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0-10) was found to accurately stratify patients into low risk (score , 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score . 1, $ 10% SAE risk). Conclusion: We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this

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Prevalence of Pulmonary Embolism in Patients With Syncope

et al. 2018

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IMPORTANCE Sparse data and conflicting evidence exist on the prevalence of pulmonary embolism (PE) in patients with syncope.OBJECTIVE To estimate the prevalence of PE among patients presenting to the emergency department (ED) for evaluation of syncope. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, observational study analyzed longitudinal administrative data from 5 databases in 4 different countries (Canada, Denmark, Italy, and the United States). Data from all adult patients (aged Ն18 years) who presented to the ED were screened to identify those with syncope codes at discharge. Data were collected from January 1, 2000, through September 30, 2016. MAIN OUTCOMES AND MEASURESThe prevalence of PE at ED and hospital discharge, identified using codes from the International Classification of Diseases, was considered the primary outcome. Two sensitivity analyses considering prevalence of PE at 90 days of follow-up and prevalence of venous thromboembolism were performed.RESULTS A total of 1 671 944 unselected adults who presented to the ED for syncope were included. The prevalence of PE, according to administrative data, ranged from 0.06% (95% CI, 0.05%-0.06%) to 0.55% (95% CI, 0.50%-0.61%) for all patients and from 0.15% (95% CI, 0.14%-0.16%) to 2.10% (95% CI, 1.84%-2.39%) for hospitalized patients. The prevalence of PE at 90 days of follow-up ranged from 0.14% (95% CI, 0.13%-0.14%) to 0.83% (95% CI, 0.80%-0.86%) for all patients and from 0.35% (95% CI, 0.34%-0.37%) to 2.63% (95% CI, 2.34%-2.95%) for hospitalized patients. Finally, the prevalence of venous thromboembolism at 90 days ranged from 0.30% (95% CI, 0.29%-0.31%) to 1.37% (95% CI, 1.33%-1.41%) for all patients and from 0.75% (95% CI, 0.73%-0.78%) to 3.86% (95% CI, 3.51%-4.24%) for hospitalized patients.CONCLUSIONS AND RELEVANCE Pulmonary embolism was rarely identified in patients with syncope. Although PE should be considered in every patient, not all patients should undergo evaluation for PE.

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The ROSE (Risk Stratification of Syncope in the Emergency Department) Study

Cited by 241 publications

References 29 publications

Syncope Risk Stratification in the Emergency Department

Syncope Risk Stratification in the Emergency Department

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Prevalence of Pulmonary Embolism in Patients With Syncope

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