The performance of the Evaluation of Guidelines in Syncope Study score in the diagnostic approach to syncope in emergency department

Abstract

BACKGROUND: Management of syncope in the emergency department (ED) is not yet well codified. Several scores have been developed to facilitate diagnosis and management. According to the European Society of Cardiology, an EGSYS (Evaluation of Guidelines in Syncope Study) score ≥3 predicts cardiac origin. OBJECTIVE: Evaluate the performance of the EGSYS score in the diagnosis of cardiac syncope in ED. METHODS: We conducted a prospective study (2011-2021). Inclusion of patients who consult for syncope with calculation of the EGSYS score. Diagnosis of cardiac syncope was based on the results of the cardiological investigation. Patients were divided into two groups: SC+ group with cardiac syncope and SC- group with another etiology. RESULTS: Inclusion of 526 patients. Mean age =49± 20 years. Gender ratio=1.48. Two hundred and thirty-six patients (45%) had a cardiac syncope. Comparison between the two groups SC+ versus (vs. SC-) showed the following results: mean age (58 ±19 vs. 42 ±18 years), history of heart disease: 34 (14.5%) vs. 13 (4.5%), rhythm disorders 22(9.4%) vs. 4(1.4%), bradycardia: 40 (17%) vs. 17 (5.8%), atrioventricular block: 26 (11.1%) vs. 8 (2.7%), bundle branch block: 45 (19.1%) vs. 17 (5.8%), High risk criteria: 138 (58.7%) vs. 75 (25.8%). Diagnostic performance of the EGSYS score was satisfactory with AUC=0.769, CI95% [0.73 - 0.81], p 0.001. The threshold value was 3. Sensitivity, specificity, positive predictive value and negative predictive value were 79, 80, 76 and 83% respectively. Likelihood Ratio: Positive LR=4.04, negative LR=0.26. CONCLUSION: The EGSYS score showed good performance in predicting the cardiac syncope.