Background: There have been several attempts to derive emergency department (ED) syncope prediction tools (SPTs) to guide ED clinician decision-making. HoweverSPTs have not been largely adopted possibly because of their lack of sensitivity and specificity. We aimed to externally validate the existing SPTs and to compare them to clinical judgment (CJ), using an individual patient data meta-analysis approach. Methods: Electronic databases, bibliographiesand experts in the field were usedto find all prospective studies enrolling consecutive subjects presenting with syncope or near syncope to the ED. Only studies reporting subsequent adverse events and those with at least one SPT and CJ were considered. SPTs and CJ were individually applied to all patients in each dataset whenever possible. Serious outcomes and death were separately considered during ED stay and at 10 and 30 days after presenting syncope episode. Pooled sensitivities, specificities, likelihood ratios and diagnostic odds ratios, with 95% CIs were calculated. Results: Thirteen potentially relevant papers were retrieved (11 authors). Six authors agreed to share individual patient data. In total, 3681 patients were included. Three SPTs (OESIL, SFSR, EGSYS) were assessable with the available datasets. None of the evaluated SPTs performed better than CJ in identifying serious outcomes during ED stay, or at 10 and 30 days after syncope. Conclusions: ED STPs do not have better sensitivity, specificity, or prognostic yield than CJ at predicting short-term serious outcome in syncope. ED clinicians should not strictly apply a SPT in their clinical practice when assessing a patient with syncope in the ED.
GIUDIZIO CLINICO E SCALE PER LA STRATIFICAZIONE DEL RISCHIO DEI PAZIENTI CHE SI PRESENTANO IN PRONTO SOCCORSO PER SINCOPE: UNA META-ANALISI DI DATI INDIVIDUALI DI SINGOLI PAZIENTI / A.m. Rusconi ; tutor: M. Cicardi ; coordinatore: M. N. Cattaneo. DIPARTIMENTO DI SCIENZE BIOMEDICHE PER LA SALUTE, 2013 Mar 25. 25. ciclo, Anno Accademico 2012. [10.13130/rusconi-anna-maria_phd2013-03-25].
GIUDIZIO CLINICO E SCALE PER LA STRATIFICAZIONE DEL RISCHIO DEI PAZIENTI CHE SI PRESENTANO IN PRONTO SOCCORSO PER SINCOPE: UNA META-ANALISI DI DATI INDIVIDUALI DI SINGOLI PAZIENTI
A.M. Rusconi
2013
Abstract
Background: There have been several attempts to derive emergency department (ED) syncope prediction tools (SPTs) to guide ED clinician decision-making. HoweverSPTs have not been largely adopted possibly because of their lack of sensitivity and specificity. We aimed to externally validate the existing SPTs and to compare them to clinical judgment (CJ), using an individual patient data meta-analysis approach. Methods: Electronic databases, bibliographiesand experts in the field were usedto find all prospective studies enrolling consecutive subjects presenting with syncope or near syncope to the ED. Only studies reporting subsequent adverse events and those with at least one SPT and CJ were considered. SPTs and CJ were individually applied to all patients in each dataset whenever possible. Serious outcomes and death were separately considered during ED stay and at 10 and 30 days after presenting syncope episode. Pooled sensitivities, specificities, likelihood ratios and diagnostic odds ratios, with 95% CIs were calculated. Results: Thirteen potentially relevant papers were retrieved (11 authors). Six authors agreed to share individual patient data. In total, 3681 patients were included. Three SPTs (OESIL, SFSR, EGSYS) were assessable with the available datasets. None of the evaluated SPTs performed better than CJ in identifying serious outcomes during ED stay, or at 10 and 30 days after syncope. Conclusions: ED STPs do not have better sensitivity, specificity, or prognostic yield than CJ at predicting short-term serious outcome in syncope. ED clinicians should not strictly apply a SPT in their clinical practice when assessing a patient with syncope in the ED.File | Dimensione | Formato | |
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