Retrospective Evaluation of Emergency Physician Judgment and Risk Scoring in Syncope Discharge Decisions
Abstract
Background: The aim of this study was to compare emergency physician discharge decisions for syncope patients in the emergency department (ED) with two established risk stratification tools: the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score and the San Francisco Syncope Rule (SFSR).
Methods: We retrospectively reviewed medical records of adult patients presenting to a university hospital ED with syncope from 2013 to 2017. High-risk classification was defined as an OESIL score ≥2 or at least one positive SFSR criterion. Physician decisions were categorized as high-risk if the patient was hospitalized. Patients were classified as having reflex, cardiac, or orthostatic hypotension syncope. The discharge decisions made by physicians were compared with OESIL and SFSR scores. Sensitivity, specificity, and predictive values for 1-year mortality were calculated.
Results: Among 457 patients included (median age 36, 95% reflex syncope), 411 (89.9%) were discharged from the ED. Based on risk scores, 114 (OESIL) and 139 (SFSR) patients were categorized as high risk. Concordance between physician decisions and risk scores was low (Kappa = 0.09 for OESIL, 0.12 for SFSR). The OESIL score demonstrated the highest sensitivity (77.8%) for predicting 1-year mortality, while the physician’s decision showed the highest specificity (91%).
Conclusions: While physician decisions showed higher specificity, OESIL scores were more sensitive in identifying highrisk patients. In young, low-risk populations, reliance on clinical judgment may be reasonable, but a combined use of scoring tools and physician assessment could improve patient safety.
Keywords
Supporting Institution
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical Statement
The Ethics Committee of the Gazi University approved the study on July 26, 2019 (Reference: 227/2019). As our study was retrospective and organised using information from patient records in the hospital's electronic medical record, patient consent was not obtained.
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