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Role of brain natriuretic peptide (BNP) in risk stratification of adult syncope
  1. Matthew J Reed1,
  2. David E Newby2,
  3. Andrew J Coull3,
  4. Keith G Jacques1,
  5. Robin J Prescott4,
  6. Alasdair J Gray1
  1. 1
    Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2
    Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
  3. 3
    Department of Medicine of the Elderly, Royal Infirmary of Edinburgh, Edinburgh, UK
  4. 4
    Medical Statistical Unit, Public Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK
  1. Dr Matthew J Reed, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK; mattreed1{at}hotmail.com

Abstract

Aims: To assess the value of a near-patient brain natriuretic peptide (BNP) test to predict medium term (3 month) serious outcome for adult syncope patients presenting to a UK emergency department (ED).

Methods: This was a prospective cohort pilot study. Consecutive patients aged ⩾16 years presenting with syncope over a 3 month period were eligible for prospective enrolment. All patients who were medium or high risk according to our ED’s existing syncope guidelines underwent near-patient BNP testing using the Triage point of care machine.

Results: 99 patients were recruited. 72 of 82 high and medium risk patients underwent BNP measurement. 11 patients had a serious outcome, 9 of whom had BNP measured. In 25 (35%) patients, BNP was ⩾100 pg/ml, and in 3 of these it was >1000 pg/ml. 6 of the 25 patients (24%) with a BNP >100 pg/ml, and all 3 patients with a BNP >1000 pg/ml, were in the serious outcome group. BNP was raised over 100 pg/ml in 6 of the 9 serious outcome patients having a BNP measured (66%), and over 1000 pg/ml in 3 (33%).

Conclusions: This early work suggests that BNP may have a role in the risk assessment of syncope patients in the ED. Further work is required to see how BNP interacts with other clinical variables. Near-patient BNP testing may be shown to be an independent predictor of adverse outcome either alone or incorporated into existing syncope clinical decision rules and scores in order to improve their sensitivity and specificity. Further studies are required to evaluate this.

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Footnotes

  • Competing interests: The near-patient BNP test strips and Triage point of care machine were supplied by Biosite.

  • Abbreviations:
    BNP
    brain natriuretic peptide
    CT
    computed tomography
    ECG
    electrocardiogram
    ED
    emergency department
    EPR
    electronic patient records
    IQR
    interquartile range

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