Predicting short-term adverse outcomes in the geriatric pop-ulation presenting with syncope: a comparison of existing syncope rules and beyond
Suud A.Kiradoh1
Timothy E.Craven2
Maria O.Rangel3
Lillian M.Nosow1
Erfan Zarrinkhoo1
Suma Menon1
Parag A.Chevli1
Tareq M.Islam1
Luqman A.Thazhatuveetil-Kunhahamed1
1.Department of Internal Medicine,Atrium Health Wake Forest Baptist Medical Center,Winston-Salem,USA2.Bios-tatistics,Epidemiology,Research,and Design(BERD),Atrium Health Wake Forest Baptist Medical Center,Winston-Salem,USA3.Department of Cardiology,Atrium Health Wake Forest Baptist Medical Center,USA
摘要：OBJECTIVES Syncope at age 65+ is associated with increased mortality, irrespective of cause. Syncope rules were designed to aid in risk-stratification but were only validated in the general adult population. Our objective was to determine if they can be ap-plied to a geriatric population in predicting short-term adverse outcomes. METHODS In this single-center retrospective study, we evaluated 350 patients aged 65+ presenting with syncope. Exclusion criteria included confirmed non-syncope, active medical condition, drug or alcohol-related syncope. Patients were stratified into high or low risk based on Canadian Syncope Risk Score (CSRS), Evaluation of Guidelines in Syncope Study (EGSYS), San Fran-cisco Syncope Rule (SFSR), and Risk Stratification of Syncope in the Emergency Department (ROSE). Composite adverse out-comes at 48-hour and 30-day included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), return emergency department visit, hospitalization, or medical intervention. We assessed each score's ability to predict the outcomes us-ing logistic-regression and compared performances using receiver-operator curves. Multivariate analyses were performed to study the associations between recorded parameters and outcomes. RESULTS CSRS outperformed with AUC of 0.732 (95％ CI: 0.653-0.812) and 0.749 (95％ CI: 0.688-0.809) for 48-h and 30-day out-comes, respectively. Sensitivities for CSRS, EGSYS, SFSR, and ROSE for 48-hour outcomes were 48％, 65％, 42％ and 19％; and for 30-day outcomes were 72％, 65％, 30％ and 55％, respectively. Atrial fibrillation/flutter on EKG, congestive heart failure, antiar-rhythmics, systolic blood-pressure < 90 at triage, and associated chest pain highly correlated with 48-h outcomes. An EKG abnor-mality, heart disease history, severe pulmonary hypertension, BNP > 300, vasovagal predisposition, and antidepressants highly correlated with 30-day outcomes. CONCLUSIONS Performance and accuracy of four prominent syncope rules were suboptimal in identifying high-risk geriat-ric patients with short-term adverse outcomes. We identified some significant clinical and laboratory information that may play a role in predicting short-term adverse events in a geriatric cohort.
机标关键词：beyondwithadversecomparisonexistinggeriatricoutcomespop-ulation
论文发表日期：2023-01-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：12( 11-22 )