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    Patent Pending

    EGSYS (Evaluation of Guidelines in SYncope Study) Score for Syncope

    Predicts likelihood that syncope is from cardiac cause.
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    INSTRUCTIONS

    Note: We recommend the San Francisco Syncope Rule over other syncope risk stratification scores, as it is the most widely validated.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting to the emergency department with syncope.

    • May have limited generalizability—in the study, a cardiologist specializing in syncope was available to review the EKG in the emergency setting.
    • Includes specific criteria for EKG abnormalities.
    • Less sensitive (95%) than the San Francisco Syncope Rule (96–98%).

    Cardiac syncope carries high mortality if untreated. A score that identifies these patients can help prevent adverse outcomes from underlying cardiac pathology.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    The EGSYS authors suggest the score be used as an aid for emergency physicians for screening, not as a substitute for clinical judgment in syncope management.

    Critical Actions

    Patients with suspected cardiogenic syncope should be referred to a cardiologist.

    Formula

    Addition of the selected points:

    Finding

    Points

    Abnormal EKG1 and/or heart disease2

    +3

    Palpitations before syncope

    +4

    Syncope during effort

    +3

    Syncope in supine position

    +2

    Autonomic prodromes3

    -1

    Predisposing and/or precipitating factors4

    -1

    1. Sinus bradycardia, AV block >1st degree, BBB, acute or old MI, SVT or VT, left or right ventricular hypertrophy, ventricular preexcitation, long QT, or Brugada pattern.
    2. Previous clinical or laboratory diagnosis of any form of structural heart disease, including ischemic heart disease, valvular dysfunction, myocardiopathies and congenital heart disease; previous diagnosis or clinical evidence of CHF; physical signs of structural heart disease.
    3. Nausea/vomiting.
    4. Warm or crowded place, prolonged orthostasis, fear/pain/other emotion.

    Facts & Figures

    Interpretation:

    EGSYS

    Interpretation

    Mortality at 21–24 months

    ≥3

    Cardiac syncope likely (95% sensitive)

    17%

    <3

    Cardiac syncope less likely

    3%

    Dr. Attilio Del Rosso

    About the Creator

    Attilio Del Rosso, MD, is in the department of cardiology at S. Giuseppe Hospital in Empoli, Italy.

    To view Dr. Attilio Del Rosso's publications, visit PubMed