Early standardized clinical judgement for syncope diagnosis in the emergency department

du Fay de Lavallaz, J. and Badertscher, P. and Zimmermann, T. and Nestelberger, T. and Walter, J. and Strebel, I. and Coelho, C. and Miró, Ò and Salgado, E. and Christ, M. and Geigy, N. and Cullen, L. and Than, M. and Javier Martin-Sanchez, F. and Di Somma, S. and Frank Peacock, W. and Morawiec, B. and Wussler, D. and Keller, D. I. and Gualandro, D. and Michou, E. and Kühne, M. and Lohrmann, J. and Reichlin, T. and Mueller, C. and Basel IX Investigators, . (2021) Early standardized clinical judgement for syncope diagnosis in the emergency department. Journal of Internal Medicine, 290 (3). pp. 728-739.

[img] PDF - Published Version
Restricted to Repository staff only

PDF - Accepted Version

Official URL: https://edoc.unibas.ch/87842/

Downloads: Statistics Overview


The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).; Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score.; In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1-year follow-up. Secondary aims included direct comparison with high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ.; Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84-0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70-0.76)), hs-cTnI (0.77 (95% CI: 0.73-0.80)) and BNP (0.77 (95% CI: 0.74-0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy.; ESCJ including a standardized syncope-specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs-cTnI and BNP.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:du Fay de Lavallaz, Jeanne and Badertscher, Patrick and Zimmermann, Tobias and Nestelberger, Thomas and Kühne, Michael and Lohrmann, Jens and Reichlin, Tobias and Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
edoc DOI:
Last Modified:30 May 2022 12:41
Deposited On:25 May 2022 08:21

Repository Staff Only: item control page