Evaluation und Risikostratifizierung der Patienten mit Synkope in der Notaufnahme

Evaluation of syncope patients in the emergency department (ED) is challenging due to the broad spectrum of differential diagnosis ranging from benign to life-threatening conditions. We examined the accuracy of two syncope decision tools (San Francisco Syncope Rule, Bos-ton Criteria) in a German ED. Study design, methods: This is a single-center, retrospective study of patients presenting with syncope or near-syncope to the ED of the Nuremberg Hospital. The primary endpoint is defined as adverse outcome during hospitalization or 7-day follow-up after discharge. Results: 440 of 28477 patients (1.5%) presenting with syncope to our ED and complete fol-low-up were included in the analysis. 79.3% of patients were hospitalized and 84 patients (19.01%) experienced the primary endpoint. Cardiac and arrhythmic conditions (39.3%), significant hemorrhage or anemia (16.7%) and severe infections (20.2 %) were the main causes of serious adverse events. Using the San Francisco Syncope Rule or Boston criteria for prediction of the primary endpoint, 57 of 84 patients (sensitivity: 67.9%; specificity: 71.0%; negative predictive value: 90.0%) or 74 of 84 patients would have been identified (sensitivity: 88.1%; specificity: 46.6%; negative predictive value: 94.3%). The sensitivity of each decision strategy increases with age and increasing rates of comorbid conditions, while the specificity of decision rules is lost. Conclusion: Patients with syncope presenting to a German ED display a high proportion of life-threatening conditions. Clinical decision tools for syncope evaluation, which have been promising in US-american EDs, show an unacceptable low sensitivity to identify patients at increased risk for short-term adverse events.