Early standardized clinical judgement for syncope diagnosis in the emergency department
Background The diagnosis of cardiac syncope remains a challenge in the emergency department (ED). Objective 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 multivar...
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| Veröffentlicht in: | Journal of internal medicine 2021-09, Vol.290 (3), p.728-739 |
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| creator | du Fay de Lavallaz, J. Badertscher, P. Zimmermann, T. Nestelberger, T. Walter, J. Strebel, I. Coelho, C. Miró, Ò. Salgado, E. Christ, M. Geigy, N. Cullen, L. Than, M. Javier Martin‐Sanchez, F. Di Somma, S. Frank Peacock, W. Morawiec, B. Wussler, D. Keller, D. I. Gualandro, D. Michou, E. Kühne, M. Lohrmann, J. Reichlin, T. Mueller, C. Flores, Dayana Widmer, Velina Breidthardt, Tobias Bustamante Mandrión, José Poepping, Imke Kawecki, Damian Muzyk, Piotr Belkin, Maria Puelacher, Christian Lopez Ayala, Pedro Freese, Michael Boeddinghaus, Jasper Diebold, Matthias Koechlin, Luca Greenslade, Jaimi Hawkins, Tracey Rentsch, Katharina von Eckardstein, Arnold Buser, Andreas Campodarve, Isabel Gea, Joachim Cruz, Helena Mañé Calderon, Sofìa Fuenzalida Inostroza, Carolina Isabel Briñón, Miguel Angel García Suárez Cadenas, María Bingisser, Roland Osswald, Stefan |
| description | Background
The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).
Objective
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.
Methods
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.
Results
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 |
| doi_str_mv | 10.1111/joim.13269 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2504342613</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2568096576</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3939-a91ca6ce30509a16c42015d61fa4d15e68856643d1b1c28080c9663a1fff346e3</originalsourceid><addsrcrecordid>eNp90E1LxDAQBuAgiq4fF3-ABLyIUE2aZrY5iviJ4kXxWGIyXbO06Zq0SP31Zl314MG5zOWZl-ElZJ-zE57mdN659oSLHNQamXABMsunCtbJhClZZFDmbItsxzhnjAsGbJNsCTGVMqEJeb7QoRlp7LW3Olj3gZaaxnlndEPng51hi76ndRdoHL3pFkit0zPfRRep87R_RZpImKE3I7W40KFfXuySjVo3Efe-9w55urx4PL_O7h6ubs7P7jIjlFCZVtxoMCiYZEpzMEXOuLTAa11YLhHKUgIUwvIXbvKSlcwoAKF5XdeiABQ75GiVuwjd24Cxr1oXDTaN9tgNscolK0SRAxeJHv6h824IPn2XFJRMgZxCUscrZUIXY8C6WgTX6jBWnFXLuqtl3dVX3QkffEcOLy3aX_rTbwJ8Bd5dg-M_UdXtw839KvQT57mKEA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2568096576</pqid></control><display><type>article</type><title>Early standardized clinical judgement for syncope diagnosis in the emergency department</title><source>MEDLINE</source><source>Wiley Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Wiley Online Library All Journals</source><creator>du Fay de Lavallaz, J. ; Badertscher, P. ; Zimmermann, T. ; Nestelberger, T. ; Walter, J. ; Strebel, I. ; Coelho, C. ; Miró, Ò. ; Salgado, E. ; Christ, M. ; Geigy, N. ; Cullen, L. ; Than, M. ; Javier Martin‐Sanchez, F. ; Di Somma, S. ; Frank Peacock, W. ; Morawiec, B. ; Wussler, D. ; Keller, D. I. ; Gualandro, D. ; Michou, E. ; Kühne, M. ; Lohrmann, J. ; Reichlin, T. ; Mueller, C. ; Flores, Dayana ; Widmer, Velina ; Breidthardt, Tobias ; Bustamante Mandrión, José ; Poepping, Imke ; Kawecki, Damian ; Muzyk, Piotr ; Belkin, Maria ; Puelacher, Christian ; Lopez Ayala, Pedro ; Freese, Michael ; Boeddinghaus, Jasper ; Diebold, Matthias ; Koechlin, Luca ; Greenslade, Jaimi ; Hawkins, Tracey ; Rentsch, Katharina ; von Eckardstein, Arnold ; Buser, Andreas ; Campodarve, Isabel ; Gea, Joachim ; Cruz, Helena Mañé ; Calderon, Sofìa ; Fuenzalida Inostroza, Carolina Isabel ; Briñón, Miguel Angel García ; Suárez Cadenas, María ; Bingisser, Roland ; Osswald, Stefan</creator><creatorcontrib>du Fay de Lavallaz, J. ; Badertscher, P. ; Zimmermann, T. ; Nestelberger, T. ; Walter, J. ; Strebel, I. ; Coelho, C. ; Miró, Ò. ; Salgado, E. ; Christ, M. ; Geigy, N. ; Cullen, L. ; Than, M. ; Javier Martin‐Sanchez, F. ; Di Somma, S. ; Frank Peacock, W. ; Morawiec, B. ; Wussler, D. ; Keller, D. I. ; Gualandro, D. ; Michou, E. ; Kühne, M. ; Lohrmann, J. ; Reichlin, T. ; Mueller, C. ; Flores, Dayana ; Widmer, Velina ; Breidthardt, Tobias ; Bustamante Mandrión, José ; Poepping, Imke ; Kawecki, Damian ; Muzyk, Piotr ; Belkin, Maria ; Puelacher, Christian ; Lopez Ayala, Pedro ; Freese, Michael ; Boeddinghaus, Jasper ; Diebold, Matthias ; Koechlin, Luca ; Greenslade, Jaimi ; Hawkins, Tracey ; Rentsch, Katharina ; von Eckardstein, Arnold ; Buser, Andreas ; Campodarve, Isabel ; Gea, Joachim ; Cruz, Helena Mañé ; Calderon, Sofìa ; Fuenzalida Inostroza, Carolina Isabel ; Briñón, Miguel Angel García ; Suárez Cadenas, María ; Bingisser, Roland ; Osswald, Stefan ; BASEL IX Investigators ; for the BASEL IX Investigators</creatorcontrib><description>Background
The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).
Objective
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.
Methods
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.
Results
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.
Conclusion
ESCJ including a standardized syncope‐specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs‐cTnI and BNP.</description><identifier>ISSN: 0954-6820</identifier><identifier>EISSN: 1365-2796</identifier><identifier>DOI: 10.1111/joim.13269</identifier><identifier>PMID: 33755279</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Accuracy ; Biomarkers ; Calcium-binding protein ; Clinical Reasoning ; Diagnosis ; Diagnostic systems ; early clinical judgement ; Early Diagnosis ; emergency department ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; Heart ; Humans ; Natriuretic Peptide, Brain ; Patients ; Prospective Studies ; risk‐stratification ; Syncope ; Syncope - diagnosis ; Syncope - etiology ; Troponin ; Troponin I</subject><ispartof>Journal of internal medicine, 2021-09, Vol.290 (3), p.728-739</ispartof><rights>2021 Association for Publication of The Journal of Internal Medicine</rights><rights>2021 Association for Publication of The Journal of Internal Medicine.</rights><rights>2021 The Association for the Publication of the Journal of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3939-a91ca6ce30509a16c42015d61fa4d15e68856643d1b1c28080c9663a1fff346e3</citedby><cites>FETCH-LOGICAL-c3939-a91ca6ce30509a16c42015d61fa4d15e68856643d1b1c28080c9663a1fff346e3</cites><orcidid>0000-0002-0806-1786 ; 0000-0001-6077-6941</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjoim.13269$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjoim.13269$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27923,27924,45573,45574,46408,46832</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33755279$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>du Fay de Lavallaz, J.</creatorcontrib><creatorcontrib>Badertscher, P.</creatorcontrib><creatorcontrib>Zimmermann, T.</creatorcontrib><creatorcontrib>Nestelberger, T.</creatorcontrib><creatorcontrib>Walter, J.</creatorcontrib><creatorcontrib>Strebel, I.</creatorcontrib><creatorcontrib>Coelho, C.</creatorcontrib><creatorcontrib>Miró, Ò.</creatorcontrib><creatorcontrib>Salgado, E.</creatorcontrib><creatorcontrib>Christ, M.</creatorcontrib><creatorcontrib>Geigy, N.</creatorcontrib><creatorcontrib>Cullen, L.</creatorcontrib><creatorcontrib>Than, M.</creatorcontrib><creatorcontrib>Javier Martin‐Sanchez, F.</creatorcontrib><creatorcontrib>Di Somma, S.</creatorcontrib><creatorcontrib>Frank Peacock, W.</creatorcontrib><creatorcontrib>Morawiec, B.</creatorcontrib><creatorcontrib>Wussler, D.</creatorcontrib><creatorcontrib>Keller, D. I.</creatorcontrib><creatorcontrib>Gualandro, D.</creatorcontrib><creatorcontrib>Michou, E.</creatorcontrib><creatorcontrib>Kühne, M.</creatorcontrib><creatorcontrib>Lohrmann, J.</creatorcontrib><creatorcontrib>Reichlin, T.</creatorcontrib><creatorcontrib>Mueller, C.</creatorcontrib><creatorcontrib>Flores, Dayana</creatorcontrib><creatorcontrib>Widmer, Velina</creatorcontrib><creatorcontrib>Breidthardt, Tobias</creatorcontrib><creatorcontrib>Bustamante Mandrión, José</creatorcontrib><creatorcontrib>Poepping, Imke</creatorcontrib><creatorcontrib>Kawecki, Damian</creatorcontrib><creatorcontrib>Muzyk, Piotr</creatorcontrib><creatorcontrib>Belkin, Maria</creatorcontrib><creatorcontrib>Puelacher, Christian</creatorcontrib><creatorcontrib>Lopez Ayala, Pedro</creatorcontrib><creatorcontrib>Freese, Michael</creatorcontrib><creatorcontrib>Boeddinghaus, Jasper</creatorcontrib><creatorcontrib>Diebold, Matthias</creatorcontrib><creatorcontrib>Koechlin, Luca</creatorcontrib><creatorcontrib>Greenslade, Jaimi</creatorcontrib><creatorcontrib>Hawkins, Tracey</creatorcontrib><creatorcontrib>Rentsch, Katharina</creatorcontrib><creatorcontrib>von Eckardstein, Arnold</creatorcontrib><creatorcontrib>Buser, Andreas</creatorcontrib><creatorcontrib>Campodarve, Isabel</creatorcontrib><creatorcontrib>Gea, Joachim</creatorcontrib><creatorcontrib>Cruz, Helena Mañé</creatorcontrib><creatorcontrib>Calderon, Sofìa</creatorcontrib><creatorcontrib>Fuenzalida Inostroza, Carolina Isabel</creatorcontrib><creatorcontrib>Briñón, Miguel Angel García</creatorcontrib><creatorcontrib>Suárez Cadenas, María</creatorcontrib><creatorcontrib>Bingisser, Roland</creatorcontrib><creatorcontrib>Osswald, Stefan</creatorcontrib><creatorcontrib>BASEL IX Investigators</creatorcontrib><creatorcontrib>for the BASEL IX Investigators</creatorcontrib><title>Early standardized clinical judgement for syncope diagnosis in the emergency department</title><title>Journal of internal medicine</title><addtitle>J Intern Med</addtitle><description>Background
The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).
Objective
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.
Methods
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.
Results
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.
Conclusion
ESCJ including a standardized syncope‐specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs‐cTnI and BNP.</description><subject>Accuracy</subject><subject>Biomarkers</subject><subject>Calcium-binding protein</subject><subject>Clinical Reasoning</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>early clinical judgement</subject><subject>Early Diagnosis</subject><subject>emergency department</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>Heart</subject><subject>Humans</subject><subject>Natriuretic Peptide, Brain</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>risk‐stratification</subject><subject>Syncope</subject><subject>Syncope - diagnosis</subject><subject>Syncope - etiology</subject><subject>Troponin</subject><subject>Troponin I</subject><issn>0954-6820</issn><issn>1365-2796</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90E1LxDAQBuAgiq4fF3-ABLyIUE2aZrY5iviJ4kXxWGIyXbO06Zq0SP31Zl314MG5zOWZl-ElZJ-zE57mdN659oSLHNQamXABMsunCtbJhClZZFDmbItsxzhnjAsGbJNsCTGVMqEJeb7QoRlp7LW3Olj3gZaaxnlndEPng51hi76ndRdoHL3pFkit0zPfRRep87R_RZpImKE3I7W40KFfXuySjVo3Efe-9w55urx4PL_O7h6ubs7P7jIjlFCZVtxoMCiYZEpzMEXOuLTAa11YLhHKUgIUwvIXbvKSlcwoAKF5XdeiABQ75GiVuwjd24Cxr1oXDTaN9tgNscolK0SRAxeJHv6h824IPn2XFJRMgZxCUscrZUIXY8C6WgTX6jBWnFXLuqtl3dVX3QkffEcOLy3aX_rTbwJ8Bd5dg-M_UdXtw839KvQT57mKEA</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>du Fay de Lavallaz, J.</creator><creator>Badertscher, P.</creator><creator>Zimmermann, T.</creator><creator>Nestelberger, T.</creator><creator>Walter, J.</creator><creator>Strebel, I.</creator><creator>Coelho, C.</creator><creator>Miró, Ò.</creator><creator>Salgado, E.</creator><creator>Christ, M.</creator><creator>Geigy, N.</creator><creator>Cullen, L.</creator><creator>Than, M.</creator><creator>Javier Martin‐Sanchez, F.</creator><creator>Di Somma, S.</creator><creator>Frank Peacock, W.</creator><creator>Morawiec, B.</creator><creator>Wussler, D.</creator><creator>Keller, D. I.</creator><creator>Gualandro, D.</creator><creator>Michou, E.</creator><creator>Kühne, M.</creator><creator>Lohrmann, J.</creator><creator>Reichlin, T.</creator><creator>Mueller, C.</creator><creator>Flores, Dayana</creator><creator>Widmer, Velina</creator><creator>Breidthardt, Tobias</creator><creator>Bustamante Mandrión, José</creator><creator>Poepping, Imke</creator><creator>Kawecki, Damian</creator><creator>Muzyk, Piotr</creator><creator>Belkin, Maria</creator><creator>Puelacher, Christian</creator><creator>Lopez Ayala, Pedro</creator><creator>Freese, Michael</creator><creator>Boeddinghaus, Jasper</creator><creator>Diebold, Matthias</creator><creator>Koechlin, Luca</creator><creator>Greenslade, Jaimi</creator><creator>Hawkins, Tracey</creator><creator>Rentsch, Katharina</creator><creator>von Eckardstein, Arnold</creator><creator>Buser, Andreas</creator><creator>Campodarve, Isabel</creator><creator>Gea, Joachim</creator><creator>Cruz, Helena Mañé</creator><creator>Calderon, Sofìa</creator><creator>Fuenzalida Inostroza, Carolina Isabel</creator><creator>Briñón, Miguel Angel García</creator><creator>Suárez Cadenas, María</creator><creator>Bingisser, Roland</creator><creator>Osswald, Stefan</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0806-1786</orcidid><orcidid>https://orcid.org/0000-0001-6077-6941</orcidid></search><sort><creationdate>202109</creationdate><title>Early standardized clinical judgement for syncope diagnosis in the emergency department</title><author>du Fay de Lavallaz, J. ; Badertscher, P. ; Zimmermann, T. ; Nestelberger, T. ; Walter, J. ; Strebel, I. ; Coelho, C. ; Miró, Ò. ; Salgado, E. ; Christ, M. ; Geigy, N. ; Cullen, L. ; Than, M. ; Javier Martin‐Sanchez, F. ; Di Somma, S. ; Frank Peacock, W. ; Morawiec, B. ; Wussler, D. ; Keller, D. I. ; Gualandro, D. ; Michou, E. ; Kühne, M. ; Lohrmann, J. ; Reichlin, T. ; Mueller, C. ; Flores, Dayana ; Widmer, Velina ; Breidthardt, Tobias ; Bustamante Mandrión, José ; Poepping, Imke ; Kawecki, Damian ; Muzyk, Piotr ; Belkin, Maria ; Puelacher, Christian ; Lopez Ayala, Pedro ; Freese, Michael ; Boeddinghaus, Jasper ; Diebold, Matthias ; Koechlin, Luca ; Greenslade, Jaimi ; Hawkins, Tracey ; Rentsch, Katharina ; von Eckardstein, Arnold ; Buser, Andreas ; Campodarve, Isabel ; Gea, Joachim ; Cruz, Helena Mañé ; Calderon, Sofìa ; Fuenzalida Inostroza, Carolina Isabel ; Briñón, Miguel Angel García ; Suárez Cadenas, María ; Bingisser, Roland ; Osswald, Stefan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3939-a91ca6ce30509a16c42015d61fa4d15e68856643d1b1c28080c9663a1fff346e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Accuracy</topic><topic>Biomarkers</topic><topic>Calcium-binding protein</topic><topic>Clinical Reasoning</topic><topic>Diagnosis</topic><topic>Diagnostic systems</topic><topic>early clinical judgement</topic><topic>Early Diagnosis</topic><topic>emergency department</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital</topic><topic>Heart</topic><topic>Humans</topic><topic>Natriuretic Peptide, Brain</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>risk‐stratification</topic><topic>Syncope</topic><topic>Syncope - diagnosis</topic><topic>Syncope - etiology</topic><topic>Troponin</topic><topic>Troponin I</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>du Fay de Lavallaz, J.</creatorcontrib><creatorcontrib>Badertscher, P.</creatorcontrib><creatorcontrib>Zimmermann, T.</creatorcontrib><creatorcontrib>Nestelberger, T.</creatorcontrib><creatorcontrib>Walter, J.</creatorcontrib><creatorcontrib>Strebel, I.</creatorcontrib><creatorcontrib>Coelho, C.</creatorcontrib><creatorcontrib>Miró, Ò.</creatorcontrib><creatorcontrib>Salgado, E.</creatorcontrib><creatorcontrib>Christ, M.</creatorcontrib><creatorcontrib>Geigy, N.</creatorcontrib><creatorcontrib>Cullen, L.</creatorcontrib><creatorcontrib>Than, M.</creatorcontrib><creatorcontrib>Javier Martin‐Sanchez, F.</creatorcontrib><creatorcontrib>Di Somma, S.</creatorcontrib><creatorcontrib>Frank Peacock, W.</creatorcontrib><creatorcontrib>Morawiec, B.</creatorcontrib><creatorcontrib>Wussler, D.</creatorcontrib><creatorcontrib>Keller, D. I.</creatorcontrib><creatorcontrib>Gualandro, D.</creatorcontrib><creatorcontrib>Michou, E.</creatorcontrib><creatorcontrib>Kühne, M.</creatorcontrib><creatorcontrib>Lohrmann, J.</creatorcontrib><creatorcontrib>Reichlin, T.</creatorcontrib><creatorcontrib>Mueller, C.</creatorcontrib><creatorcontrib>Flores, Dayana</creatorcontrib><creatorcontrib>Widmer, Velina</creatorcontrib><creatorcontrib>Breidthardt, Tobias</creatorcontrib><creatorcontrib>Bustamante Mandrión, José</creatorcontrib><creatorcontrib>Poepping, Imke</creatorcontrib><creatorcontrib>Kawecki, Damian</creatorcontrib><creatorcontrib>Muzyk, Piotr</creatorcontrib><creatorcontrib>Belkin, Maria</creatorcontrib><creatorcontrib>Puelacher, Christian</creatorcontrib><creatorcontrib>Lopez Ayala, Pedro</creatorcontrib><creatorcontrib>Freese, Michael</creatorcontrib><creatorcontrib>Boeddinghaus, Jasper</creatorcontrib><creatorcontrib>Diebold, Matthias</creatorcontrib><creatorcontrib>Koechlin, Luca</creatorcontrib><creatorcontrib>Greenslade, Jaimi</creatorcontrib><creatorcontrib>Hawkins, Tracey</creatorcontrib><creatorcontrib>Rentsch, Katharina</creatorcontrib><creatorcontrib>von Eckardstein, Arnold</creatorcontrib><creatorcontrib>Buser, Andreas</creatorcontrib><creatorcontrib>Campodarve, Isabel</creatorcontrib><creatorcontrib>Gea, Joachim</creatorcontrib><creatorcontrib>Cruz, Helena Mañé</creatorcontrib><creatorcontrib>Calderon, Sofìa</creatorcontrib><creatorcontrib>Fuenzalida Inostroza, Carolina Isabel</creatorcontrib><creatorcontrib>Briñón, Miguel Angel García</creatorcontrib><creatorcontrib>Suárez Cadenas, María</creatorcontrib><creatorcontrib>Bingisser, Roland</creatorcontrib><creatorcontrib>Osswald, Stefan</creatorcontrib><creatorcontrib>BASEL IX Investigators</creatorcontrib><creatorcontrib>for the BASEL IX Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>du Fay de Lavallaz, J.</au><au>Badertscher, P.</au><au>Zimmermann, T.</au><au>Nestelberger, T.</au><au>Walter, J.</au><au>Strebel, I.</au><au>Coelho, C.</au><au>Miró, Ò.</au><au>Salgado, E.</au><au>Christ, M.</au><au>Geigy, N.</au><au>Cullen, L.</au><au>Than, M.</au><au>Javier Martin‐Sanchez, F.</au><au>Di Somma, S.</au><au>Frank Peacock, W.</au><au>Morawiec, B.</au><au>Wussler, D.</au><au>Keller, D. I.</au><au>Gualandro, D.</au><au>Michou, E.</au><au>Kühne, M.</au><au>Lohrmann, J.</au><au>Reichlin, T.</au><au>Mueller, C.</au><au>Flores, Dayana</au><au>Widmer, Velina</au><au>Breidthardt, Tobias</au><au>Bustamante Mandrión, José</au><au>Poepping, Imke</au><au>Kawecki, Damian</au><au>Muzyk, Piotr</au><au>Belkin, Maria</au><au>Puelacher, Christian</au><au>Lopez Ayala, Pedro</au><au>Freese, Michael</au><au>Boeddinghaus, Jasper</au><au>Diebold, Matthias</au><au>Koechlin, Luca</au><au>Greenslade, Jaimi</au><au>Hawkins, Tracey</au><au>Rentsch, Katharina</au><au>von Eckardstein, Arnold</au><au>Buser, Andreas</au><au>Campodarve, Isabel</au><au>Gea, Joachim</au><au>Cruz, Helena Mañé</au><au>Calderon, Sofìa</au><au>Fuenzalida Inostroza, Carolina Isabel</au><au>Briñón, Miguel Angel García</au><au>Suárez Cadenas, María</au><au>Bingisser, Roland</au><au>Osswald, Stefan</au><aucorp>BASEL IX Investigators</aucorp><aucorp>for the BASEL IX Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early standardized clinical judgement for syncope diagnosis in the emergency department</atitle><jtitle>Journal of internal medicine</jtitle><addtitle>J Intern Med</addtitle><date>2021-09</date><risdate>2021</risdate><volume>290</volume><issue>3</issue><spage>728</spage><epage>739</epage><pages>728-739</pages><issn>0954-6820</issn><eissn>1365-2796</eissn><abstract>Background
The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).
Objective
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.
Methods
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.
Results
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.
Conclusion
ESCJ including a standardized syncope‐specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs‐cTnI and BNP.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>33755279</pmid><doi>10.1111/joim.13269</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0806-1786</orcidid><orcidid>https://orcid.org/0000-0001-6077-6941</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0954-6820 |
| ispartof | Journal of internal medicine, 2021-09, Vol.290 (3), p.728-739 |
| issn | 0954-6820 1365-2796 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2504342613 |
| source | MEDLINE; Wiley Free Content; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals |
| subjects | Accuracy Biomarkers Calcium-binding protein Clinical Reasoning Diagnosis Diagnostic systems early clinical judgement Early Diagnosis emergency department Emergency medical care Emergency medical services Emergency Service, Hospital Heart Humans Natriuretic Peptide, Brain Patients Prospective Studies risk‐stratification Syncope Syncope - diagnosis Syncope - etiology Troponin Troponin I |
| title | Early standardized clinical judgement for syncope diagnosis in the emergency department |
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