Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Sep;11(5):134-44.
Epub 2011 Oct 2.

Application Of The American College Of Emergency Physicians (ACEP) Recommendations And a Risk Stratification Score (OESIL) For Patients With Syncope Admitted From The Emergency Department

Adrian Baranchuk  1 , William McIntyre, William Harper, Carlos A Morillo
Affiliations

Application Of The American College Of Emergency Physicians (ACEP) Recommendations And a Risk Stratification Score (OESIL) For Patients With Syncope Admitted From The Emergency Department

Adrian Baranchuk et al. Indian Pacing Electrophysiol J. 2011 Sep.

Abstract

Aims: The goals of this study were to apply the 2001 ACEP recommendations for admission to hospital after a syncopal event and to validate the OESIL risk stratification score, in patients with syncope admitted to a general internal medicine ward.

Methods: A retrospective study applied the 2001 ACEP recommendations and OESIL score to all the patients admitted from the emergency department to a general internal medicine ward with a diagnosis of syncope during a 12-month period. The patients were classified as meeting criteria for 2001 ACEP class B or C recommendations and OESIL score 0-1 (low-risk for a major cardiac event) or 2-4 (high-risk for a major cardiac event). The sensitivity and specificity of each group for predicting high-risk patients was calculated.

Results: After applying the 2001 ACEP recommendations to our population, 25% (19 patients) were classified as level B, whereas 68% of the patients were classified as Level C. Sensitivity for ACEP level B recommendations was 100% and specificity was 81%. The ACEP level C recommendations also had 100% sensitivity but markedly reduced specificity at 26%. An OESIL score of 0-1 points was calculated for 30.6% of the population, identifying them as low-risk. An OESIL score of 2-4 points was documented in the remaining 69.4% with a mortality risk of 20 % /year.

Conclusion: A significant proportion (30%) of patients presenting with syncope to a tertiary care University Hospital emergency department and admitted to an Internal Medicine ward were retrospectively classified as low-risk and could have potentially been managed as outpatients. Implementing current guidelines and clinical pathways for the management of syncope may improve this approach.

Keywords: ACEP recommendations; OESIL score; Syncope.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percentages of patients admitted from the emergency department according to calculated 2001 ACEP recommendation and OESIL risk score
Figure 2
Figure 2
Kaplan-Meier survival curves by OESIL syncope score for patients admitted from the ED with syncope
See this image and copyright information in PMC

References

    1. American College of Emergency Physicians Clinical Policies Subcommittee on Syncope, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Syncope. Ann Emerg Med. 2007;49:431. - PubMed
    1. Sun BC, et al. Characteristics and admission patterns of patients presenting with syncope to U.S. emergency departments, 1992-2000. Acad Emerg Med. 2004;11:1029. - PubMed
    1. Brignole M, et al. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J. 2001;22:1256. - PubMed
    1. Ammirati F, et al. Diagnosing syncope in the clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial - the OESIL 2 Study (Osservatorio Epidemioologico dell Sincope nel Lazio) Eur Heart J. 2000;21:935. - PubMed
    1. Sheldon R, et al. Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J . 2006;27:344. - PubMed

LinkOut - more resources