0067: The SYNCSCOR study: validation of a risk stratification tool for syncope in the emergency department

BackgroundSyncope is a frequent symptom for admission in the Emergency Department (ED). The SYNCSCOR tool is developed with clinical parameters of the ESC recommendations 2009 and validated scores regarding syncope to help the clinician for patients (pts) orientation (cf table): intensive (≥2), differed (=1) or no further evaluation (0).MethodsIn this non interventionnal monocentric study, pts admitted in the ED of Grenoble University Hospital for syncope were prospectively included from July 2013 to January 2014. The SYNCSCOR was calculated a posteriori for all pts. The main objective was to validate the tool for the prediction of serious outcomes within 3 months (death, major cardiovascular events, cardiovascular interventional therapy, return to hospital for a related event).Results94 pts were included (males 54%, mean age 66 years old, history of cardiopathy 56%). 97% had biological testing in the ED and 77% imaging evaluation. After the ED evaluation, 39% were admitted (hospitalization>12H), 45% were addressed to outpatient clinic and 16% were released. In 64% of cases, a diagnostic was done in the ED.Serious outcomes occurred in 25 pts. The sensitivity and specificity, of SYNCSCOR for the primary criteria was 96% (95% Confidence interval [CI] 80 to 99%) and 24% (95% CI 16 to 36%) whereas 88% (95% CI 70 to 96%) and 18% (95% CI 7% to 24%) for the ED clinician alone. The negative predictive value of the tool was 94% (95% CI 73 to 99%). According to SYNSCOR, 50% of pts should benefit from an intensive evaluation and 20% can have a direct release.ConclusionSYNCSCOR is a useful screening tool to improve reliability to the recommendations in the ED. It can help to limit no necessary complementary exams, overprescribed for patients at low risk, and to lead patients to an immediate intensive evaluation (syncope unit) in case of high risk criteria. As SYNCSCOR is only based on clinical parameters, this tool can be easily proposed in the community care.Abstract 0067 – Figure: Resume of SYNCSCOR parametersPrevious History: cardiopathy or familial sudden cardiac death+2 ptsCircumstances: exercise, supine, palpitations, chest pain+2 ptsTraumatic syncope+1 ptAbnormal clinical exam+2 ptsAbnormal EKG: ESC criteria + 2 other conduction disturbance or Q wave + 1+2 or -1 pts0: discharge 1: differed evaluation ≥2: intensive immediate evaluatio