Abstract
Study purposeRoutine transthoracic echocardiography (TTE) in patients with syncope or presyncope is resource-intensive. We assessed if risk thresholds defined by a validated risk score may identify patients at low risk of cardiac abnormality in whom TTE is unnecessary.Study designWe conducted a retrospective study of all general medicine patients with syncope/presyncope presenting to a tertiary hospital between July 2016 and September 2020 and who underwent TTE. The Canadian Syncope Risk Score (CSRS) was used to categorise patients as low to very low risk (score −3 to 0) or moderate to high risk (score ≥1) for serious adverse events at 30 days. A cut-point of 0 was used to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for CSRS and the odds ratio (OR) of a clinically significant finding on TTE in patients with CSRS ≥1 compared with all patients.ResultsAmong 157 patients, the CSRS categorised 69 (44%) as very low to low risk in whom TTE was normal. In 88 patients deemed moderate to high risk, TTE detected a cardiac abnormality in 24 (27%). A CSRS ≥1 yielded a sensitivity of 100% (95% CI 85.7% to 100%), specificity of 51.1% (95% CI 42.3% to 59.8%), PPV of 26.5% (95% CI 26.3% to 30.1%) and NPV of 100% (95% CI 92.5% to 100%) for cardiac abnormalities and doubled the odds of an abnormality (OR=2.05, 95% CI 1.08 to 3.87, p=0.028).ConclusionIn general medicine patients with syncope/presyncope, using the CSRS to stratify risk of a cardiac abnormality on TTE can almost halve TTE use.
Publisher
Oxford University Press (OUP)
Reference30 articles.
1. Medicare Australia Statistics . Medicare item reports, 2014. Available: https://www.medicareaustralia.gov.au/statistics/mbs_item.shtml
2. Medicare Benefits Schedule Review Taskforce . Report from the cardiac services clinical Committee. Canberra: Australian government department of health, 2017. https://www.health.gov.au/resources/collections/mbs-review-final-taskforce-reports-findings-and-recommendations
3. Predictors of clinically significant echocardiography findings in older adults with syncope: a secondary analysis;Probst;J Hosp Med,2018
4. Role of emergency department observation units in the management of patients with unexplained syncope: a critical review and meta-analysis;Numeroso;Clin Exp Emerg Med,2017
5. Outcomes in presyncope patients: a prospective cohort study;Thiruganasambandamoorthy;Ann Emerg Med,2015
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献