Syncope is a transient loss of consciousness with full recovery, and is a common presenting problem to the emergency department (ED). Most patients presenting with syncope have a benign cause, but others may be at risk for serious adverse outcomes. The problem is that there is currently no validated tool for knowing which patients are at risk and which can be safely discharged. Several clinical prediction rules have been developed over the years, however the sensitivity and specificity of these rules vary. This has led to an over-admission of patients who could otherwise be safely discharged, based on clinician discretion. These patients are subjected to multiple tests, including cardiac telemetry for monitoring which not only has low yield, but also results in significant costs to the healthcare system.
The Canadian Syncope Risk Score (CSRS) is the latest decision tool developed in an attempt to predict serious outcomes in patients presenting with syncope to the ED, but it has not yet been validated. This study aims to validate the CSRS at a single site, providing the first step in guiding clinicians to make better risk assessments and disposition decisions for patients with syncope. Furthermore, an innovative economic model will assess the impact of this decision tool on the healthcare system. This project is the first, critical phase toward better informed decision-making by clinicians for patients with syncope. Ultimately, this tool will enable a change to clinical practice that will result in improved patient outcomes and enhanced, targeted healthcare delivery.
Pictured to the right: Members of the Syncope research team from left to right: Ms Helena Cooney, Dr Alan Yan, Dr Jason Chan, Dr Emma Ballard (QIMR), Dr Jonathan Hunter and Dr David Brain (AusHSI)
The study demonstrated that patients categorised as low risk according to the decision tool could be safely discharged from the emergency department. An economic analysis based on modelling showed cost benefits to the healthcare system if hospitalisations of low risk patients were avoided.
- Chan J., Hunter J., Morel D., Ballard E., Brain D., Yan A., Hocking J., “Evaluating patients presenting to the emergency department after syncope: validation of the Canadian Syncope Risk Score”, MJA, 2019 May. doi: 10.5694/mja2.50147
Dr Jason Chan
Dr Jonathan Hunter
Dr Alan Yan
Dr David Brain
A/Prof Douglas Morel