Du Fay De Lavallaz, J;
Badertscher, P B;
Zimmermann, T Z;
Nestelberger, T N;
Walter, J W;
Strebel, I S;
Lohrmann, J S;
Boeddinghaus, J B;
Miro, O M;
Than, M T;
Martin-Sanchez, J M S;
Cullen, L C;
Kuehne, M K;
Reichlin, T;
Mueller, C M
P6570Performance of the early clinical judgement for the diagnosis of syncope on the emergency department
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Media type:
E-Article
Title:
P6570Performance of the early clinical judgement for the diagnosis of syncope on the emergency department
Contributor:
Du Fay De Lavallaz, J;
Badertscher, P B;
Zimmermann, T Z;
Nestelberger, T N;
Walter, J W;
Strebel, I S;
Lohrmann, J S;
Boeddinghaus, J B;
Miro, O M;
Than, M T;
Martin-Sanchez, J M S;
Cullen, L C;
Kuehne, M K;
Reichlin, T;
Mueller, C M
Description:
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Clinical judgement of the emergency department (ED) physician at time of discharge outperforms prognostic risk scores but the early clinical judgment (ECJ) regarding diagnosis has never been assessed.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We evaluated the diagnostic accuracy of the ED physicians' ECJ 90 minutes after admission of patients >40 years presenting with syncope to the ED in a prospective diagnostic multicenter study. Cardiac syncope, as adjudicated by two physicians based on information available including 1-year follow-up, was the diagnostic endpoint. Death and MACE were the prognostic endpoints. Lasso-regression was used to identify variables contributing most to the ECJ or to the diagnosis of cardiac syncope. Syncope-specific diagnostic and prognostic scores, high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) were used for comparison.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of the ECJ for cardiac syncope, as quantified by the Area Under the Curve (AUC), was 0.87 (95% CI 0.84–0.89) and was superior to the one of biomarkers and diagnostic score, constant between all centers, but poorly calibrated. 16 variables available very-early on the ED achieved a comparable performance (AUC 0.84 (95% CI 0.82–0.87), p=0.136).</jats:p>
<jats:p>The extrapolated prognostic accuracy of the ECJ was moderate for MACE (AUC 0.73–0.8) but poor for death (0.58–0.63) over two years follow-up.</jats:p>
<jats:p>Figure 1</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>The ECJ performs well for the diagnosis of cardiac syncope but a similar accuracy can be obtained using structured variables obtained very-early in the diagnostic process.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Acknowledgement/Funding</jats:title>
<jats:p>Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation, Basel (Switzerland), University Basel (Switzerland)</jats:p>
</jats:sec>