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Annals of emergency medicine
02, 2020;75 (2): 147-158.

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

Marc A Probst, Thomas Gibson, Robert E Weiss, Annick N Yagapen, Susan E Malveau, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Carol L Clark, Deborah B Diercks, Judd E Hollander, Bret A Nicks, Daniel K Nishijima, Manish N Shah, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, Benjamin C Sun
Author Information
  1. Marc A Probst: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: mprobst@gmail.com.
  2. Thomas Gibson: Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA.
  3. Robert E Weiss: Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA.
  4. Annick N Yagapen: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
  5. Susan E Malveau: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
  6. David H Adler: Department of Emergency Medicine, University of Rochester, Rochester, NY.
  7. Aveh Bastani: Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
  8. Christopher W Baugh: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
  9. Jeffrey M Caterino: Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
  10. Carol L Clark: Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI.
  11. Deborah B Diercks: Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX.
  12. Judd E Hollander: Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
  13. Bret A Nicks: Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
  14. Daniel K Nishijima: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
  15. Manish N Shah: Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI.
  16. Kirk A Stiffler: Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH.
  17. Alan B Storrow: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
  18. Scott T Wilber: Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH.
  19. Benjamin C Sun: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
PMID: 31668571 DOI: 10.1016/j.annemergmed.2019.08.429

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.

Associated Data

ClinicalTrials.gov | NCT01802398

References

  1. Ann Emerg Med. 2003 Sep;42(3):395-402 [PMID: 12944893]
  2. JAMA Intern Med. 2015 Jun;175(6):1065-7 [PMID: 25894921]
  3. Ann Emerg Med. 2018 Dec;72(6):654-664 [PMID: 30119942]
  4. Eur Heart J. 2016 May 14;37(19):1493-8 [PMID: 26242712]
  5. Lancet. 2000 Oct 14;356(9238):1318-21 [PMID: 11073021]
  6. Ann Emerg Med. 2015 Dec;66(6):689 [PMID: 26590749]
  7. Am J Emerg Med. 2007 Sep;25(7):774-9 [PMID: 17870480]
  8. Stroke. 2010 Jun;41(6):1298-300 [PMID: 20413737]
  9. Isr Med Assoc J. 2008 Feb;10(2):104-8 [PMID: 18432020]
  10. J Thromb Haemost. 2004 Aug;2(8):1247-55 [PMID: 15304025]
  11. Ann Emerg Med. 2018 Nov;72(5):523-532 [PMID: 30342727]
  12. Heart. 2008 Dec;94(12):1620-6 [PMID: 18519550]
  13. Ann Emerg Med. 2014 Sep;64(3):286-91 [PMID: 24530108]
  14. Am J Emerg Med. 2015 Aug;33(8):998-1001 [PMID: 25943042]
  15. CMAJ. 2017 Nov 13;189(45):E1379-E1385 [PMID: 29133539]
  16. Clin Chem. 2012 Jan;58(1):54-61 [PMID: 21965555]
  17. J Am Coll Cardiol. 2008 Jan 22;51(3):276-83 [PMID: 18206736]
  18. Heart. 2005 May;91(5):606-12 [PMID: 15831643]
  19. J Emerg Med. 2004 Nov;27(4):339-43 [PMID: 15498613]
  20. J Emerg Med. 2007 Oct;33(3):233-9 [PMID: 17976548]
  21. Crit Pathw Cardiol. 2010 Sep;9(3):164-9 [PMID: 20802272]
  22. Ann Emerg Med. 2007 Apr;49(4):420-7, 427.e1-4 [PMID: 17210201]
  23. Acad Emerg Med. 2015 Aug;22(8):934-41 [PMID: 26204970]
  24. CMAJ. 2016 Sep 6;188(12):E289-E298 [PMID: 27378464]
  25. Intern Emerg Med. 2015 Aug;10(5):619-27 [PMID: 25918108]
  26. Ann Emerg Med. 2008 Aug;52(2):151-9 [PMID: 18282636]
  27. Ann Emerg Med. 2017 Sep;70(3):338-344.e3 [PMID: 28238497]
  28. Ann Emerg Med. 2004 Nov;44(5):503-10 [PMID: 15520710]
  29. Am J Emerg Med. 2013 Nov;31(11):1546-50 [PMID: 24055476]
  30. Cardiol J. 2014;21(6):643-50 [PMID: 25299508]
  31. Acad Emerg Med. 2012 Jun;19(6):694-702 [PMID: 22687184]
  32. Am J Cardiol. 2014 Jan 1;113(1):98-102 [PMID: 24169011]
  33. Ann Emerg Med. 2007 Apr;49(4):431-44 [PMID: 17371707]
  34. Ann Emerg Med. 2004 Feb;43(2):224-32 [PMID: 14747812]
  35. Acad Emerg Med. 2017 Apr;24(4):458-466 [PMID: 27859997]
  36. Ann Emerg Med. 2010 May;55(5):464-72 [PMID: 19944489]
  37. JAMA. 2013 Sep 25;310(12):1248-55 [PMID: 24065011]
  38. JAMA. 1992 Nov 11;268(18):2553-60 [PMID: 1404823]
  39. West J Emerg Med. 2018 May;19(3):517-523 [PMID: 29760850]
  40. Circulation. 2018 Jan 16;137(3):250-258 [PMID: 29030346]
  41. Emerg Med J. 2007 Nov;24(11):769-73 [PMID: 17954830]
  42. Ann Emerg Med. 2011 Sep;58(3):250-6 [PMID: 21288597]
  43. J Am Coll Cardiol. 2017 Aug 1;70(5):620-663 [PMID: 28286222]
  44. Ann Emerg Med. 2009 Dec;54(6):769-778.e1-5 [PMID: 19766355]
  45. Am J Emerg Med. 2019 May;37(5):810-816 [PMID: 30054114]
  46. Am J Cardiol. 2004 Jan 15;93(2):228-30 [PMID: 14715356]
  47. Am J Ophthalmol. 2010 Feb;149(2):187-188.e1 [PMID: 20103051]
  48. Am J Cardiol. 2005 Mar 1;95(5):668-71 [PMID: 15721118]
  49. J Eval Clin Pract. 2000 May;6(2):193-204 [PMID: 10970013]
  50. Acad Emerg Med. 2013 May;20(5):487-97 [PMID: 23672363]
  51. Ann Emerg Med. 2018 Dec;72(6):665-667 [PMID: 30243545]
  52. Eur Heart J. 2003 May;24(9):811-9 [PMID: 12727148]
  53. Cerebrovasc Dis. 2012;33(2):182-9 [PMID: 22237056]
  54. Cardiovasc Diagn Ther. 2016 Jun;6(3):234-40 [PMID: 27280086]
  55. Acad Emerg Med. 2004 Oct;11(10):1029-34 [PMID: 15466144]
  56. Ann Emerg Med. 1997 Apr;29(4):459-66 [PMID: 9095005]
  57. Ann Emerg Med. 2010 Oct;56(4):362-373.e1 [PMID: 20868906]
  58. Int J Cardiol. 2009 Mar 20;133(1):51-4 [PMID: 18237792]
  59. Ann Emerg Med. 2019 Aug;74(2):187-203 [PMID: 30718010]
  60. J Am Coll Cardiol. 2010 Feb 23;55(8):713-21 [PMID: 20170806]
  61. Intern Emerg Med. 2015 Dec;10(8):1003-14 [PMID: 26498335]
  62. Heart. 2006 Jun;92(6):843-9 [PMID: 16698841]
  63. Am J Emerg Med. 2005 Oct;23(6):782-6 [PMID: 16182988]
  64. Ann Emerg Med. 2014 Dec;64(6):649-55.e2 [PMID: 24882667]
  65. Stat Med. 2004 May 30;23(10):1631-60 [PMID: 15122742]

Grants

  1. K23 HL132052/NHLBI NIH HHS
  2. R01 HL111033/NHLBI NIH HHS

MeSH Term

Aged
Area Under Curve
Cardiovascular Diseases
Emergency Service, Hospital
Female
Health Status Indicators
Humans
Male
Practice Guidelines as Topic
Prospective Studies
Risk Assessment
Syncope
United States
Journal Article Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't
Article has an altmetric score of 55

Word Cloud

Created with Highcharts 10.0.00syncopecardiac95%FAINTadultsseriousCIolderyearsnearoutcome7%scoreOlderEDtool30-dayoutcomesunexplainedprimary9%historyelevatedversussensitivity8%STUDYOBJECTIVE:commonlytreatedemergencydepartmentseekderivenovelrisk-stratificationpredictMETHODS:performedprospectiveobservationalstudy≥60presented11EDsUnitedStatesPatientsdiagnosisidentifiedexcludedcollectedclinicallaboratorydatapatientsall-causemortalityRESULTS:enrolled3177April2013September2016Meanage73SD9incidence5confidenceinterval[CI]465%UsingBayesianlogisticregressionderivedscore:heartfailurearrhythmiainitialabnormalECGresultproB-typenatriureticpeptidehigh-sensitivitytroponinTgreaterequal1969298specificity222%2023respectivelytendedaccurateunstructuredphysicianjudgment:areacurve704669739630589670CONCLUSION:Amongpotentialcausezeroreasonablyhighexcludingdeath30daysexternallyvalidatedimproveresourceusecommonconditionRiskStratificationAdultsPresentEmergencyDepartmentSyncope:Score

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