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International Validation of the Canadian Syncope Risk Score: A Cohort Study

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International Validation of the Canadian Syncope Risk Score: A Cohort Study. / Zimmermann, Tobias; du Fay de Lavallaz, Jeanne; Nestelberger, Thomas; Gualandro, Danielle M; Lopez-Ayala, Pedro; Badertscher, Patrick; Widmer, Velina; Shrestha, Samyut; Strebel, Ivo; Glarner, Noemi; Diebold, Matthias; Miró, Òscar; Christ, Michael; Cullen, Louise; Than, Martin; Martin-Sanchez, F Javier; Di Somma, Salvatore; Peacock, W Frank; Keller, Dagmar I; Bilici, Murat; Costabel, Juan Pablo; Kühne, Michael; Breidthardt, Tobias; Thiruganasambandamoorthy, Venkatesh; Mueller, Christian; BASEL IX Investigators.

In: ANN INTERN MED, Vol. 175, No. 6, 06.2022, p. 783-794.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Zimmermann, T, du Fay de Lavallaz, J, Nestelberger, T, Gualandro, DM, Lopez-Ayala, P, Badertscher, P, Widmer, V, Shrestha, S, Strebel, I, Glarner, N, Diebold, M, Miró, Ò, Christ, M, Cullen, L, Than, M, Martin-Sanchez, FJ, Di Somma, S, Peacock, WF, Keller, DI, Bilici, M, Costabel, JP, Kühne, M, Breidthardt, T, Thiruganasambandamoorthy, V, Mueller, C & BASEL IX Investigators 2022, 'International Validation of the Canadian Syncope Risk Score: A Cohort Study', ANN INTERN MED, vol. 175, no. 6, pp. 783-794. https://doi.org/10.7326/M21-2313

APA

Zimmermann, T., du Fay de Lavallaz, J., Nestelberger, T., Gualandro, D. M., Lopez-Ayala, P., Badertscher, P., Widmer, V., Shrestha, S., Strebel, I., Glarner, N., Diebold, M., Miró, Ò., Christ, M., Cullen, L., Than, M., Martin-Sanchez, F. J., Di Somma, S., Peacock, W. F., Keller, D. I., ... BASEL IX Investigators (2022). International Validation of the Canadian Syncope Risk Score: A Cohort Study. ANN INTERN MED, 175(6), 783-794. https://doi.org/10.7326/M21-2313

Vancouver

Zimmermann T, du Fay de Lavallaz J, Nestelberger T, Gualandro DM, Lopez-Ayala P, Badertscher P et al. International Validation of the Canadian Syncope Risk Score: A Cohort Study. ANN INTERN MED. 2022 Jun;175(6):783-794. https://doi.org/10.7326/M21-2313

Bibtex

@article{41918e713c4e43e6a38aa0e6d617ca75,
title = "International Validation of the Canadian Syncope Risk Score: A Cohort Study",
abstract = "BACKGROUND: The Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes not evident during emergency department (ED) evaluation.OBJECTIVE: To externally validate the CSRS and compare it with another validated score, the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) score.DESIGN: Prospective cohort study.SETTING: Large, international, multicenter study recruiting patients in EDs in 8 countries on 3 continents.PARTICIPANTS: Patients with syncope aged 40 years or older presenting to the ED within 12 hours of syncope.MEASUREMENTS: Composite outcome of serious clinical plus procedural events (primary outcome) and the primary composite outcome excluding procedural interventions (secondary outcome).RESULTS: Among 2283 patients with a mean age of 68 years, the primary composite outcome occurred in 7.2%, and the composite outcome excluding procedural interventions occurred in 3.1% at 30 days. Prognostic performance of the CSRS was good for both 30-day composite outcomes and better compared with the OESIL score (area under the receiver-operating characteristic curve [AUC], 0.85 [95% CI, 0.83 to 0.88] vs. 0.74 [CI, 0.71 to 0.78] and 0.80 [CI, 0.75 to 0.84] vs. 0.69 [CI, 0.64 to 0.75], respectively). Safety of triage, as measured by the frequency of the primary composite outcome in the low-risk group, was higher using the CSRS (19 of 1388 [0.6%]) versus the OESIL score (17 of 1104 [1.5%]). A simplified model including only the clinician classification of syncope (cardiac syncope, vasovagal syncope, or other) variable at ED discharge-a component of the CSRS-achieved similar discrimination as the CSRS (AUC, 0.83 [CI, 0.80 to 0.87] for the primary composite outcome).LIMITATION: Unable to disentangle the influence of other CSRS components on clinician classification of syncope at ED discharge.CONCLUSION: This international external validation of the CSRS showed good performance in identifying patients at low risk for serious outcomes outside of Canada and superior performance compared with the OESIL score. However, clinician classification of syncope at ED discharge seems to explain much of the performance of the CSRS in this study. The clinical utility of the CSRS remains uncertain.PRIMARY FUNDING SOURCE: Swiss National Science Foundation & Swiss Heart Foundation.",
keywords = "Aged, Canada, Cohort Studies, Emergency Service, Hospital, Humans, Prospective Studies, Risk Assessment, Risk Factors, Syncope/diagnosis",
author = "Tobias Zimmermann and {du Fay de Lavallaz}, Jeanne and Thomas Nestelberger and Gualandro, {Danielle M} and Pedro Lopez-Ayala and Patrick Badertscher and Velina Widmer and Samyut Shrestha and Ivo Strebel and Noemi Glarner and Matthias Diebold and {\`O}scar Mir{\'o} and Michael Christ and Louise Cullen and Martin Than and Martin-Sanchez, {F Javier} and {Di Somma}, Salvatore and Peacock, {W Frank} and Keller, {Dagmar I} and Murat Bilici and Costabel, {Juan Pablo} and Michael K{\"u}hne and Tobias Breidthardt and Venkatesh Thiruganasambandamoorthy and Christian Mueller and {BASEL IX Investigators} and Maria Belkin and Kathrin Leu and Jens Lohrmann and Jasper Boeddinghaus and Raphael Twerenbold and Luca Koechlin and Walter, {Joan E} and Melissa Amrein and Desiree Wussler and Michael Freese and Christian Puelacher and Damian Kawecki and Beata Morawiec and Emilio Salgado and Gemma Martinez-Nadal and Inostroza, {Carolina Isabel Fuenzalida} and Mandri{\'o}n, {Jos{\'e} Bustamante} and Imke Poepping and Katharina Rentsch and {von Eckardstein}, Arnold and Andreas Buser and Jaimi Greenslade and Tobias Reichlin and Franz B{\"u}rgler",
year = "2022",
month = jun,
doi = "10.7326/M21-2313",
language = "English",
volume = "175",
pages = "783--794",
journal = "ANN INTERN MED",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "6",

}

RIS

TY - JOUR

T1 - International Validation of the Canadian Syncope Risk Score: A Cohort Study

AU - Zimmermann, Tobias

AU - du Fay de Lavallaz, Jeanne

AU - Nestelberger, Thomas

AU - Gualandro, Danielle M

AU - Lopez-Ayala, Pedro

AU - Badertscher, Patrick

AU - Widmer, Velina

AU - Shrestha, Samyut

AU - Strebel, Ivo

AU - Glarner, Noemi

AU - Diebold, Matthias

AU - Miró, Òscar

AU - Christ, Michael

AU - Cullen, Louise

AU - Than, Martin

AU - Martin-Sanchez, F Javier

AU - Di Somma, Salvatore

AU - Peacock, W Frank

AU - Keller, Dagmar I

AU - Bilici, Murat

AU - Costabel, Juan Pablo

AU - Kühne, Michael

AU - Breidthardt, Tobias

AU - Thiruganasambandamoorthy, Venkatesh

AU - Mueller, Christian

AU - BASEL IX Investigators

AU - Belkin, Maria

AU - Leu, Kathrin

AU - Lohrmann, Jens

AU - Boeddinghaus, Jasper

AU - Twerenbold, Raphael

AU - Koechlin, Luca

AU - Walter, Joan E

AU - Amrein, Melissa

AU - Wussler, Desiree

AU - Freese, Michael

AU - Puelacher, Christian

AU - Kawecki, Damian

AU - Morawiec, Beata

AU - Salgado, Emilio

AU - Martinez-Nadal, Gemma

AU - Inostroza, Carolina Isabel Fuenzalida

AU - Mandrión, José Bustamante

AU - Poepping, Imke

AU - Rentsch, Katharina

AU - von Eckardstein, Arnold

AU - Buser, Andreas

AU - Greenslade, Jaimi

AU - Reichlin, Tobias

AU - Bürgler, Franz

PY - 2022/6

Y1 - 2022/6

N2 - BACKGROUND: The Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes not evident during emergency department (ED) evaluation.OBJECTIVE: To externally validate the CSRS and compare it with another validated score, the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) score.DESIGN: Prospective cohort study.SETTING: Large, international, multicenter study recruiting patients in EDs in 8 countries on 3 continents.PARTICIPANTS: Patients with syncope aged 40 years or older presenting to the ED within 12 hours of syncope.MEASUREMENTS: Composite outcome of serious clinical plus procedural events (primary outcome) and the primary composite outcome excluding procedural interventions (secondary outcome).RESULTS: Among 2283 patients with a mean age of 68 years, the primary composite outcome occurred in 7.2%, and the composite outcome excluding procedural interventions occurred in 3.1% at 30 days. Prognostic performance of the CSRS was good for both 30-day composite outcomes and better compared with the OESIL score (area under the receiver-operating characteristic curve [AUC], 0.85 [95% CI, 0.83 to 0.88] vs. 0.74 [CI, 0.71 to 0.78] and 0.80 [CI, 0.75 to 0.84] vs. 0.69 [CI, 0.64 to 0.75], respectively). Safety of triage, as measured by the frequency of the primary composite outcome in the low-risk group, was higher using the CSRS (19 of 1388 [0.6%]) versus the OESIL score (17 of 1104 [1.5%]). A simplified model including only the clinician classification of syncope (cardiac syncope, vasovagal syncope, or other) variable at ED discharge-a component of the CSRS-achieved similar discrimination as the CSRS (AUC, 0.83 [CI, 0.80 to 0.87] for the primary composite outcome).LIMITATION: Unable to disentangle the influence of other CSRS components on clinician classification of syncope at ED discharge.CONCLUSION: This international external validation of the CSRS showed good performance in identifying patients at low risk for serious outcomes outside of Canada and superior performance compared with the OESIL score. However, clinician classification of syncope at ED discharge seems to explain much of the performance of the CSRS in this study. The clinical utility of the CSRS remains uncertain.PRIMARY FUNDING SOURCE: Swiss National Science Foundation & Swiss Heart Foundation.

AB - BACKGROUND: The Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes not evident during emergency department (ED) evaluation.OBJECTIVE: To externally validate the CSRS and compare it with another validated score, the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) score.DESIGN: Prospective cohort study.SETTING: Large, international, multicenter study recruiting patients in EDs in 8 countries on 3 continents.PARTICIPANTS: Patients with syncope aged 40 years or older presenting to the ED within 12 hours of syncope.MEASUREMENTS: Composite outcome of serious clinical plus procedural events (primary outcome) and the primary composite outcome excluding procedural interventions (secondary outcome).RESULTS: Among 2283 patients with a mean age of 68 years, the primary composite outcome occurred in 7.2%, and the composite outcome excluding procedural interventions occurred in 3.1% at 30 days. Prognostic performance of the CSRS was good for both 30-day composite outcomes and better compared with the OESIL score (area under the receiver-operating characteristic curve [AUC], 0.85 [95% CI, 0.83 to 0.88] vs. 0.74 [CI, 0.71 to 0.78] and 0.80 [CI, 0.75 to 0.84] vs. 0.69 [CI, 0.64 to 0.75], respectively). Safety of triage, as measured by the frequency of the primary composite outcome in the low-risk group, was higher using the CSRS (19 of 1388 [0.6%]) versus the OESIL score (17 of 1104 [1.5%]). A simplified model including only the clinician classification of syncope (cardiac syncope, vasovagal syncope, or other) variable at ED discharge-a component of the CSRS-achieved similar discrimination as the CSRS (AUC, 0.83 [CI, 0.80 to 0.87] for the primary composite outcome).LIMITATION: Unable to disentangle the influence of other CSRS components on clinician classification of syncope at ED discharge.CONCLUSION: This international external validation of the CSRS showed good performance in identifying patients at low risk for serious outcomes outside of Canada and superior performance compared with the OESIL score. However, clinician classification of syncope at ED discharge seems to explain much of the performance of the CSRS in this study. The clinical utility of the CSRS remains uncertain.PRIMARY FUNDING SOURCE: Swiss National Science Foundation & Swiss Heart Foundation.

KW - Aged

KW - Canada

KW - Cohort Studies

KW - Emergency Service, Hospital

KW - Humans

KW - Prospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Syncope/diagnosis

U2 - 10.7326/M21-2313

DO - 10.7326/M21-2313

M3 - SCORING: Journal article

C2 - 35467933

VL - 175

SP - 783

EP - 794

JO - ANN INTERN MED

JF - ANN INTERN MED

SN - 0003-4819

IS - 6

ER -