Retrospective evaluation of patients presenting to the emergency department with syncope

Objective: The study aims to compare the clinical usefulness of the San Francisco Syncope Rules (SFSR), Canadian Syncope Risk Score (CSRS), and Anatolian Syncope Rules (ASR) in terms of short-term prognosis and mortality prediction in patients presenting with syncope. Therefore, the contribution to the development of syncope protocols is done by applying risk scores to patients coming to the emergency department. This guides to similar studies to be done in the future, and supports the literature in the related field. Materials and Methods: This study is a retrospective, cross-sectional, and cohort study. It was conducted to patients who applied to Suleyman Demirel University Hospital Emergency Department with temporary loss of consciousness or pre-syncope complaint between 01.01.2015-01.01.2023. Findings: 39,8% (n=78) of the 196 patients included in the study were males and 60,2% (n=118) were females. There are significant differences between age, vasovagal symptoms, heart disease, pulse values, troponin elevation, HCT values, presence of abnormal EKG findings, QRS axes, corrected QT durations and total scores of CSRS, SFSR and ASK risk scores according to the cause of syncope. Among the three risk scores used to determine vasovagal syncope risk, CSRS has the highest values in terms of both sensitivity (92,97%) and specificity (98,53%). This shows that CSRS is the most reliable test in determining vasovagal syncope. Although SFSR shows close performance to CSRS in terms of sensitivity (87,50%), it has a quite low value in terms of specificity (47,06%). This shows that SFSR is good at identifying people with vasovagal syncope, but not good at accurately identifying people without syncope. Finally, ASR has the lowest values in terms of both sensitivity (67,19%) and specificity (64,71%). This suggests that ASR is less reliable than other tests used to determine vasovagal syncope. Among the three risk scores used to determine cardiac syncope, ASR has the highest value in terms of sensitivity (96,15%). This shows that ASR is very effective in identifying people with cardiac syncope. However, it has the lowest value in terms of specificity (64,12%), which shows that ASR is not good at accurately identifying people without cardiac syncope. CSRS has high values in terms of both sensitivity (92,31%) and specificity (94,12%), which shows that CSRS is a quite reliable test for determining cardiac syncope. Although SFSR shows the same performance as CSRS in terms of sensitivity (92,31%), it has a slightly lower value in terms of specificity (85,88%). This shows that SFSR is good at identifying people with cardiac syncope, but not good at accurately identifying people without syncope. Conclusion: Canadian Syncope Rules, Anatolian Syncope Rules and San Francisco Syncope Rules can also be used to identify risky patients in the Emergency Department. However, it should not be forgotten that these are only auxiliary and the main decision belongs to the clinician. Keywords: Canadian Syncope Rules, Anatolian Syncope Rules, San Francisco Syncope Rules, Risk Classification, Syncope, ICEB