Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score.

Authors

Marc A Probst
Thomas Gibson
Robert E Weiss
Annick N Yagapen
Susan E Malveau
David H Adler
Aveh Bastani, Beaumont Health
Christopher W Baugh
Jeffrey M Caterino
Carol L Clark, Beaumont Health
Deborah B Diercks
Judd E Hollander
Bret A Nicks
Daniel K Nishijima
Manish N Shah
Kirk A Stiffler
Alan B Storrow
Scott T Wilber
Benjamin C Sun

Document Type

Article

Publication Date

2-1-2020

Publication Title

Annals of emergency medicine

Abstract

STUDY OBJECTIVE: Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes.

METHODS: We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome.

RESULTS: We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670).

CONCLUSION: Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

Volume

75

Issue

2

First Page

147

Last Page

158

Recommended Citation

Probst MA, Gibson T, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score. Ann Emerg Med. 2020 Feb;75(2):147-158. doi: 10.1016/j.annemergmed.2019.08.429. Epub 2019 Oct 23. PMID: 31668571; PMCID: PMC6981063.

DOI

10.1016/j.annemergmed.2019.08.429

ISSN

1097-6760

PubMed ID

31668571