- For emergency department (ED) risk stratification in elderly people presenting after syncope, a 5-variable risk score predicted serious 30-day outcomes.
- Authors caution clinicians not to use this rule before external validation.
Why this matters
- Accurate risk stratification is the “holy grail of syncope research.”
- Low-yield hospitalizations are common.
- This study used a large elderly population, novel biomarkers, and objective criteria.
- Prospective observational multicenter study of adults aged ≥60 years presenting to EDs after unexplained syncope or near-syncope (n=3177).
- Authors used logistic regression to derive FAINT score:
- History of heart failure.
- History of arrhythmia.
- Initial abnormal ECG result.
- Elevated pro B-type natriuretic peptide.
- Elevated high-sensitivity troponin T.
- Outcome: 30-day all-cause mortality or serious cardiac outcome.
- Funding: NIH.
- Primary outcome occurred in 5.7%; mortality was 0.82%.
- Performance of FAINT score of 0 vs ≥1:
- Sensitivity: 96.7% (95% CI, 92.9%-98.8%).
- Specificity: 22.2% (95% CI, 20.7%-23.8%).
- FAINT vs unstructured physician judgment area under the curve: 0.704 (95% CI, 0.669-0.739) vs 0.630 (95% CI, 0.589-0.670).
- Risk for sampling bias.
- External validation required.