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Multicenter Study
. 2020 Feb;75(2):147-158.
doi: 10.1016/j.annemergmed.2019.08.429. Epub 2019 Oct 23.

Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score

Marc A Probst  1 , Thomas Gibson  2 , Robert E Weiss  2 , Annick N Yagapen  3 , Susan E Malveau  3 , David H Adler  4 , Aveh Bastani  5 , Christopher W Baugh  6 , Jeffrey M Caterino  7 , Carol L Clark  8 , Deborah B Diercks  9 , Judd E Hollander  10 , Bret A Nicks  11 , Daniel K Nishijima  12 , Manish N Shah  13 , Kirk A Stiffler  14 , Alan B Storrow  15 , Scott T Wilber  14 , Benjamin C Sun  16
Affiliations
Multicenter Study

Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score

Marc A Probst et al. Ann Emerg Med. 2020 Feb.

Abstract

Study objective: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes.

Methods: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome.

Results: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670).

Conclusion: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

Trial registration: ClinicalTrials.gov NCT01802398.

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Figures

Figure 1:
Figure 1:
Patient Flow Diagram
Figure 2a and 2b:
Figure 2a and 2b:
Observed vs Predicted Risk Plot
Figure 3.
Figure 3.. Comparison of the ROC Curves for the FAINT score vs. Physician Risk Assessmen
ROC: Receiver Operating Characteristic.
See this image and copyright information in PMC

Comment in

  • Feeling FAINT? Watch Out for the Grizzlies.
    Jones CW, Platts-Mills TF. Jones CW, et al. Ann Emerg Med. 2020 Feb;75(2):159-161. doi: 10.1016/j.annemergmed.2019.10.008. Epub 2019 Dec 19. Ann Emerg Med. 2020. PMID: 31866172 No abstract available.

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