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Applying the Boston syncope criteria to near syncope
Shamai A Grossman1, Matthew Babineau, Laura Burke
1Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
The Journal of Emergency Medicine
|September 18, 2012
Summary
Modified Boston Syncope Criteria (BSC) can safely reduce hospitalizations for near-syncope patients. These guidelines identify patients with dehydration or vasovagal causes who can be discharged, even with risk factors, without missing adverse outcomes.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Decision Rules
Background:
- Near-syncope patients share adverse outcome risks with syncope patients.
- The Boston Syncope Criteria (BSC) effectively identify low-risk syncope patients and reduce hospitalizations.
- The applicability of BSC to near-syncope patients for hospitalization reduction remains uncertain.
Purpose of the Study:
- To evaluate the accuracy of BSC in predicting hospitalization needs for near-syncope patients.
- To assess if modified BSC can safely reduce hospital admissions for near-syncope.
Main Methods:
- Prospective observational study of 244 emergency department patients with near syncope (August 2007-October 2008).
- Initial application of strict BSC, followed by a modified rule allowing discharge for dehydration/vasovagal causes with normal work-up, irrespective of risk factors.
- Outcomes ascertained via chart review and 30-day follow-up.
Main Results:
- 111 of 244 near-syncope patients were admitted, experiencing 49 adverse outcomes.
- No adverse outcomes were observed in discharged patients.
- Modified BSC led to a 38% reduction in admissions (68 patients) without missing adverse outcomes, compared to a strict BSC approach.
Conclusions:
- Near-syncope patients may present with risk factors similar to syncope patients.
- Patients with dehydration or vasovagal near syncope and normal emergency department work-up can be safely discharged, even if risk factors are present.
- Modified BSC offers a safe and effective strategy for reducing near-syncope hospitalizations.
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