Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score

Heart. 2008 Dec;94(12):1620-6. doi: 10.1136/hrt.2008.143123. Epub 2008 Jun 2.


Objective: To develop, in patients referred for syncope to an emergency department (ED), a diagnostic score to identify those patients likely to have a cardiac cause.

Design: Prospective cohort study.

Setting: ED of 14 general hospitals.

Patients: 516 consecutive patients with unexplained syncope.

Interventions: Subjects underwent a diagnostic evaluation on adherence to Guidelines of the European Society of Cardiology. The clinical features of syncope were analysed using a standard 52-item form. In a validation cohort of 260 patients the predictive value of symptoms/signs was evaluated, a point score was developed and then validated in a cohort of 256 other patients.

Main outcome measurements: Diagnosis of cardiac syncope, mortality.

Results: Abnormal ECG and/or heart disease, palpitations before syncope, syncope during effort or in supine position, absence of autonomic prodromes and absence of predisposing and/or precipitating factors were found to be predictors of cardiac syncope. To each variable a score from +4 to -1 was assigned to the magnitude of regression coefficient. A score >or=3 identified cardiac syncope with a sensitivity of 95%/92% and a specificity of 61%/69% in the derivation and validation cohorts, respectively. During follow-up (mean (SD) 614 (73) days) patients with score >or=3 had a higher total mortality than patients with a score <3 both in the derivation (17% vs 3%; p<0.001) and in the validation cohort (21% vs 2%; p<0.001).

Conclusions: A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in an ED.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Heart Diseases / complications*
  • Heart Diseases / diagnosis
  • Hospitalization / statistics & numerical data*
  • Hospitals, General / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Syncope / diagnosis*
  • Syncope / etiology
  • Triage / methods