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Ann Emerg Med. 2019 Oct 23. pii: S0196-0644(19)31113-8. doi: 10.1016/j.annemergmed.2019.08.429. [Epub ahead of print]

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

Author information

1
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: mprobst@gmail.com.
2
Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA.
3
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
4
Department of Emergency Medicine, University of Rochester, Rochester, NY.
5
Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
6
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
7
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
8
Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI.
9
Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX.
10
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
11
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
12
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
13
Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI.
14
Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH.
15
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
16
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.

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.

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