“Before this tool, it was very hard to tell which people were at high risk of adverse events after fainting. Now we can reliably catch these few patients, and safely send the rest home.” said Dr. Venkatesh ThiruganasambandamoorthyMost of the time fainting is harmless, but for some people it can be caused by serious conditions like irregular heartbeat.
A made-in-Ottawa tool can accurately tell emergency physicians which patients will have symptoms of these serious conditions within 30 days of fainting, according to a validation study published in JAMA Internal Medicine.
The Canadian Syncope Risk Score has the potential to catch these few patients early, but also to reduce wait times in the emergency department for the majority of fainting patients who can safely be sent home.
Based on nine pieces of information collected in the emergency department, the tool categorizes patients as being at very low, low, medium, high or at very high risk of experiencing symptoms of a serious condition within a month of fainting. These events include irregular heartbeat, heart attacks or death.
The tool was validated in a study in nine emergency departments across Canada. Of the 3,819 patients involved, 75 percent were categorized as low risk or very low risk. Overall, 3.6 percent of patients experienced serious outcomes, including 0.3 percent who died.
The research team found that 0.3 percent of very low-risk patients, 0.7 percent of low-risk patients, eight percent of medium risk patients, 20 percent of high-risk patients and 50 percent of very-high risk patients experienced a serious event within a month after fainting.
Based on the results, the research team recommends sending very-low and low-risk patients home, briefly hospitalizing high and very high-risk patients, and coming to a shared decision on care with medium-risk patients.
“Before this tool, it was very hard to tell which people were at high risk of adverse events after fainting. Now we can reliably catch these few patients, and safely send the rest home.” said Dr. Venkatesh Thiruganasambandamoorthy, lead author of the study and emergency physician and scientist at The Ottawa Hospital and associate professor at the University of Ottawa.
Source: JAMA Internal Medicine
Authors: Venkatesh Thiruganasambandamoorthy, Marco L. A. Sivilotti, Natalie Le Sage, Justin W. Yan, Paul Huang, Mona Hegdekar, Eric Mercier MD, Muhammad Mukarram MBBS, Marie-Joe Nemnom, Andrew D. McRae, Brian H Rowe, Ian Stiell, George A Wells, Andrew D Krahn, Monica Taljaard
Funding: This study was funded by the Cardiac Arrhythmia Network of Canada and the Heart and Stroke Foundation of Canada. Research at The Ottawa Hospital is possible because of generous donations to The Ottawa Hospital Foundation.
The Ottawa Hospital is a leading academic health, research and learning hospital proudly affiliated with the University of Ottawa.
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