Senkop Taburculuk Kararlarında Acil Servis Hekimi Yargısı ve Risk Skorlamasının Retrospektif Değerlendirmesi

Yıl 2026, Cilt: 7 Sayı: 1, 154 - 161, 31.01.2026

Ayfer Keleş , Gulbin Aygencel , Mehmet Ali Aslaner , Fikret Bildik , Isa Kilicaslan , Ahmet Demircan , Secdegül Coşkun Yaş , Kerem Serdar Karaşahin , Ayşe Yekta Öztürk , Ali Sami Yardımcı , Bahar Alkaş

https://doi.org/10.47482/acmr.1676186

Öz

Giriş
Bu çalışmanın amacı, senkop risk skorları ile senkop hastalarının acil servisten taburcu edilmesinde hekimler tarafından verilen kararları karşılaştırmaktır.
Yöntem
Acil servise başvuran senkop hastalarının tıbbi kayıtları retrospektif olarak incelendi. Hastalar refleks, kardiyak ve ortostatik hipotansiyon senkopu olarak sınıflandırıldı. Prodromal semptomlar ve tetikleyiciler de not edildi. Acil servis doktorlarının taburcu kararları Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk skoru ve San Francisco Senkop Kriterleri (SFRS) ile karşılaştırıldı. Mortalite için duyarlılık, özgüllük ve prediktif değerler hesaplandı.
Bulgular
Çalışmaya dahil edilen 457 hastanın (ortanca yaş 36, %95 refleks senkop) 411'i (%89,9) acil servisten taburcu edilmiştir. Risk skorlarına göre 114 (OESIL) ve 139 (SFSR) hasta yüksek riskli olarak kategorize edilmiştir. Hekim kararları ve risk skorları arasındaki uyum düşük saptanmıştır (Kappa = OESIL için 0.09, SFSR için 0.12). OESIL skoru 1 yıllık mortaliteyi öngörmede en yüksek duyarlılığı (%77,8) gösterirken, hekim kararı en yüksek özgüllüğü (%91) göstermiştir.
Sonuç
Hekim kararı daha yüksek özgüllük gösterirken, OESIL skorları yüksek riskli hastaları belirlemede daha duyarlıydı. Genç, düşük riskli popülasyonlarda klinik yargıya güvenmek makul olabilir, ancak skorlama araçlarının ve hekim değerlendirmesinin birlikte kullanılması hasta güvenliğini artırabilir.

Anahtar Kelimeler

Senkop , acil tıp , risk skorlaması

Retrospective Evaluation of Emergency Physician Judgment and Risk Scoring in Syncope Discharge Decisions

Öz

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.

Anahtar Kelimeler

Syncope , emergency medicine , risk scores

Etik Beyan

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.

Destekleyen Kurum

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Kaynakça

• Badila E, Negrea C, Ripa A, Weiss E, Bartos D, Tirziu C. The Etiology of Syncope in an Emergency Hospital. Rom J Intern Med. 2016;54(3):173-8.
• Puppala VK, Dickinson O, Benditt DG. Syncope: classification and risk stratification. J Cardiol. 2014;63(3):171-7. Snead GR, Wilbur LG. Can the San Francisco Syncope Rule predict short-term serious outcomes in patients presenting with syncope? Ann Emerg Med. 2013;62(3):267-8.
• Dipaola F, Costantino G, Solbiati M, Barbic F, Capitanio C, Tobaldini E, et al. Syncope risk stratification in the ED. Auton Neurosci. 2014;184:17-23.
• Awan A, Iftikhar H, Tiruneh F, Soherwardi S, Larbi D. Etiology and Age Distribution of Syncope in a Predominantly African-American Population. Cureus. 2017;9(6):e1354.
• Sun BC, Costantino G, Barbic F, Bossi I, Casazza G, Dipaola F, et al. Priorities for emergency department syncope research. Ann Emerg Med. 2014;64(6):649-55 e2.
• Dipaola F, Costantino G, Perego F, Borella M, Galli A, Cantoni G, et al. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio risk score, and clinical judgment in the assessment of short-term outcome of syncope. Am J Emerg Med. 2010;28(4):432-9.
• Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52(2):151-9.
• Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883-948.
• Numeroso F, Mossini G, Spaggiari E, Cervellin G. Syncope in the emergency department of a large northern Italian hospital: incidence, efficacy of a short-stay observation ward and validation of the OESIL risk score. Emerg Med J. 2010;27(9):653-8.
• Longo S, Legramante JM, Rizza S, Federici M. Vasovagal syncope: An overview of pathophysiological mechanisms. Eur J Intern Med. 2023;112:6‑14.
• Gauer RL. Evaluation of syncope. Am Fam Physician. 2011;84(6):640-50.
• Ali NJ, Grossman SA. Geriatric Syncope and Cardiovascular Risk in the Emergency Department. J Emerg Med. 2017;52(4):438-48 e3.
• Sutton R. Reflex syncope: Diagnosis and treatment. J Arrhythm. 2017;33(6):545-52.
• Albassam OT, Redelmeier RJ, Shadowitz S, Husain AM, Simel D, Etchells EE. Did This Patient Have Cardiac Syncope? The Rational Clinical Examination Systematic Review. JAMA. 2019;321(24):2448-57.
• Costantino G, Falavigna G, Solbiati M, Casagranda I, Sun BC, Grossman SA, et al. Neural networks as a tool to predict syncope risk in the Emergency Department. Europace. 2017;19(11):1891-5.
• Quinn JV, Stiell IG, McDermott DA, Sellers KL, Kohn MA, Wells GA. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med. 2004;43(2):224-32.
• Serrano LA, Hess EP, Bellolio MF, Murad MH, Montori VM, Erwin PJ, et al. Accuracy and quality of clinical decision rules for syncope in the emergency department: a systematic review and meta-analysis. Ann Emerg Med. 2010;56(4):362-73 e1.