Prognostic value of the OESIL risk score in a cohort of Emergency Department patients with syncope

Aim. The aim of this paper was to assess short and long term prognostic value of the OESIL risk score (ORS), a risk stratification rule for syncope which consider abnormal ECG, age > 65, history of cardiovascular diseases, lack of prodromal symptoms to identify patients at higher risk of mortality (ORS >= 2) to be admitted. Methods. This is a prospective cohort study in which syncopal recurrences, readmission for other reasons major therapeutic procedures, cardiovascular events, death for any reason, were assessed in a group of 200 syncopal patients at both 1 month and 1 year after discharge from an Emergency Department Observation Unit. Results. Multinomial logistic regression analysis showed that ORS >= 2 is not associated with any endpoint, except major procedures. Conversely, ORS >= 3 was a strong predictor of at least 1 adverse event within 1 month and severe outcomes within 1 year, particularly for non-syncopal readmission (P<0.005), major procedures (P<0.002), cardiovascular events (P<0.023), and death for any cause (P<0.022). Conclusion. Our patient group was significantly older than the ORS derivation cohort (72.4 +/- 15.1 vs. 59.5 +/- 24.3 yrs) and mostly above the age considered as 1 point in the ORS, so it is rather understandable that only a more restrictive cut-off might be advantageous for identifying high risk patients. On the evidence of a progressive ageing of patients presenting at the EDs, we suggest to use a (3)3 ORS threshold when deciding for admission.