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Original research
Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement
  1. Monica Solbiati1,2,
  2. Giovanni Talerico3,
  3. Paolo Villa4,
  4. Franca Dipaola5,
  5. Raffaello Furlan6,
  6. Ludovico Furlan7,
  7. Elisa Maria Fiorelli1,
  8. Filippo Rabajoli8,
  9. Ivo Casagranda9,
  10. Katia Cazzola10,
  11. Susanna Ramuscello10,
  12. Andrea Vicenzi4,
  13. Giovanni Casazza11,
  14. Giorgio Costantino2,7
  1. 1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  2. 2Dipartimento di Scienze Cliniche e di Comunita, Universita degli Studi di Milano, Milano, Italy
  3. 3Internal Medicine Unit, Policlinico Casilino, Roma, Italy
  4. 4UOC Medicina d'Urgenza e Pronto Soccorso, Ospedale Luigi Sacco, Milano, Italy
  5. 5Internal Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
  6. 6Clinical Institute Humanitas, Rozzano, Lombardia, Italy
  7. 7UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  8. 8Divisione di Cardiologia, Ospedale Santa Croce, Torino, Italy
  9. 9Università degli Studi di Pavia, Pavia, Italy
  10. 10Niguarda Hospital, Milano, Lombardia, Italy
  11. 11Università degli Studi di Milano, Milano, Italy
  1. Correspondence to Dr Giorgio Costantino, UOC Pronto Soccorso e Medicina d'Urgenza, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano 20122, Italy; giorgic2{at}gmail.com

Abstract

Background The Canadian Syncope Risk Score (CSRS) has been proposed for syncope risk stratification in the emergency department (ED). The aim of this study is to perform an external multicenter validation of the CSRS and to compare it with clinical judgement.

Methods Using patients previously included in the SyMoNE database, we enrolled subjects older than 18 years who presented reporting syncope at the ED. For each patient, we estimated the CSRS and recorded the physician judgement on the patients’ risk of adverse events. We performed a 30-day follow-up.

Results From 1 September 2015 to 28 February 2017, we enrolled 345 patients; the median age was 71 years (IQR 51–81), 174 (50%) were men and 29% were hospitalised. Serious adverse events occurred in 43 (12%) of the patients within 30 days. The area under the curve of the CSRS and clinical judgement was 0.75 (95% CI 0.68 to 0.81) and 0.68 (95% CI 0.61 to 0.74), respectively. The risk of adverse events of patients at low risk according to the CSRS and clinical judgement was 6.7% and 2%, with a sensitivity of 70% (95% CI 54% to 83%) and 95% (95% CI 84% to 99%), respectively.

Conclusion This study represents the first validation analysis of CSRS outside Canada. The overall predictive accuracy of the CSRS is similar to the clinical judgement. However, patients at low risk according to clinical judgement had a lower incidence of adverse events as compared with patients at low risk according to the CSRS. Further studies showing that the adoption of the CSRS improve patients’ outcomes is warranted before its widespread implementation.

  • syncope
  • diagnosis
  • arrythmia

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to giorgic2@gmail.com.

https://doi.org/10.1136/emermed-2020-210579

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to giorgic2@gmail.com.

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    Footnotes

    • Handling editor Richard Body

    • Contributors MS, GT, GCa and GCo designed the study; PV, FD, LF, EMF, FR, IC, KC, SR, MR and AV collected the data; MS, GT, GCa, GCo analysed and interpreted the data; MS, GT, GCa and GCo drafted the manuscript; all the authors critically revised the manuscript for important intellectual content; GCa provided statistical expertise.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.