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OESIL Score for Syncope

Calculators  Cardiovascular
The OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Score for Syncope estimates the risk of death from any cause within 12 months since the initial syncope.
Age >65 years
No 0
Yes 1
Cardiovascular disease in clinical history
Structural heart disease, CHF, PAD, stroke/TIA
No 0
Yes 1
Syncope without prodrome
No 0
Yes 1
Abnormal EKG
Arrhythmia, AV conduction disorders, BBB, conduction delay, LV or RV hypertrophy, left axis deviation, old MI, ST segment or T wave abnormalities related to ischemia
No 0
Yes 1
Result:

Background

Measured Factor
Risk of death from any cause within 12 months since the initial syncope.
Measured Factor Disease
  • High risk of mortality
  • High risk for a major cardiac event
Measured Factor Detail
The OESIL Score for Syncope estimates the risk of death from any cause within 12 months since the initial syncope. Predictors of mortality include age >65 years, cardiovascular disease history (e.g., structural heart disease, congestive heart failure, peripheral artery disease, stroke, transient ischemic attack), syncope without prodromes, and abnormal electrocardiogram (e.g., arrhythmia, atrioventricular conduction disorders, conduction delay, etc.). The calculator helps with risk stratification of patients presenting with syncopes, especially syncopes due to cardiac causes, in emergency departments.
Speciality
Emergency Medicine Physician
Body System
Cardiovascular
Measured Factor High Impact
  • High risk of mortality
  • High risk for a major cardiac event

Result Interpretation

Ranges Ranges
  • Critical High: Scores ≥ 2
  • Normal: Score 0
  • Normal Adult Male: Score 0
  • Normal Adult Female: Score 0
  • Normal Geriatric Male: Score 0
  • Normal Geriatric Female: Score 0
Result High Conditions
  • High risk of mortality
  • High risk for a major cardiac event
Test Limitations
The OESIL risk score only takes into account information at the initial presentation to the emergency department. It does not include the effects of therapeutic intervention, laboratory assessment, and the cause of syncopy, which might influence mortality risk.
References: 1

Studies

Study Validation 1
This prospective study investigated the utility of troponin T level taken at least 4 hours after a syncope and the OESIL score in predicting post-syncope outcome. A total of enrolled 113 adult patients presented to emergency department after a syncope were enrolled in the study. They were were followed up via telephone after 3 to 6 months and their medical records were examined. An elevated troponin T level was found to be highly specific (0.99, 95% confidence interval 0.96-1.0) for adverse cardiac outcomes, but its sensitivity was low (0.13, 95% CI 0-0.3). The OESIL risk score was predictive of adverse cardiac outcome (receiver-operating characteristic 0.73, 95% CI 0.63-0.84). The study concluded that the OESIL score might be reliable in predicting post-syncope outcome.
References: 2
Study Validation 2
This study analyzed the incidence of syncope at the emergency department of University Hospital of Parma in the first half of 2008, evaluated the efficacy of a brief observation unit, and validated the OESIL risk score in identifying cardiogenic syncopes. Syncopes occured in 2.3% of cases in the emergency department and in 4.2% of total hospital admissions. A brief observation unit in the emergency department helped manage syncope cases quickly in about 3.5 days. The most common type of syncope was non-cardiogenic. Ahigh OESIL risk score as well as previous syncopal events and a lack of prodromal symptoms were found to be associated with cardiogenic syncopes.
References: 3
Study Validation 3
The EGSYS-U (Evaluation of Guidelines in SYncope Study-univariate), EGSYS-M (Evaluation of Guidelines in SYncope Study-multivariate), and OESIL risk scores were compared for their utility in classifying cardiac syncopes. A total of 153 patients with syncope were admitted to the Faculty Hospital in Ostrava in the year 2008. Three score systems had strong correlation (Spearman correlation coefficient: r = 0.71 p < 0.0001 for EGSYS-U and OESIL, r = 0.88 p < 0.0001 for EGSYS-U and EGSYS-M, r = 0.60 p < 0.0001 for EGSYS-M and OESIL). Sensitivity and specificity of the scores were computed and compared. The study concluded that all three score systems were capable of classifying cardiac syncopes. EGSYS-U was recommended because of its high sensitivity and specificity.
References: 4
Study Additional 1
This prospective cohort study assessed the prognostic value of the OESIL risk score in 200 syncopal patients at both 1 month and 1 year after discharge from an Emergency Department Observation Unit. An OESIL risk score ≥ 2 was associated only with major procedures. An OESIL risk score ≥ 3 predicted at least 1 adverse event within 1 month and severe outcomes within 1 year 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).
References: 5
Study Additional 2
This retrospective study applied the 2001 American College Of Emergency Physicians (ACEP) recommendations and validated the OESIL risk score. The patients were classified as meeting criteria for 2001 ACEP class B or C recommendations. OESIL scores of 0-1 point indicated low-risk for a major cardiac event and OESIL scores of 2-4 points indicated high-risk for a major cardiac event. There were 25% of patients classified as level B, and 68% of patients classified as level C. Sensitivity for ACEP level B recommendations was 100% and specificity was 81%. Sensitivity for ACEP level C recommendations was 100% sensitivity and specificity was 26%. An OESIL score of 0-1 points was found in 30.6% of patients with a low mortality risk. An OESIL score of 2-4 points was found in 69.4% of patient with a high mortality risk (20%  per year). The authors suggested that patients classified as low-risk according to the OESIL score might be managed as outpatients.
References: 6

Authors

Furio Colivicchi, MD, FESC, FACC, FANMCO, is a clinical cardiologist in Rome, Italy. He is the President Elect of the Italian National Association of Hospital Cardiologists (ANMCO, www.en.anmco.it). He is also the director of Cardiology at San Filippo Neri Hospital. Dr. Colivicchi’s research interests include clinical cardiovascular pharmacology and secondary cardiovascular prevention.
https://www.researchgate.net/profile/Furio_Colivicchi

References

  1. Colivicchi F, Ammirati F, Melina D, Guido V, Imperoli G, Santini M; OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators. Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J. 2003 May;24(9):811-9.
  2. Hing R, Harris R. Relative utility of serum troponin and the OESIL score in syncope. Emerg Med Australas. 2005 Feb;17(1):31-8.
  3. 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 Sep;27(9):653-8.
  4. Plasek J, Doupal V, Fürstova J, Martinek A. The EGSYS and OESIL risk scores for classification of cardiac etiology of syncope: comparison, revaluation, and clinical implications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Jun;154(2):169-73.
  5. Numeroso F, Mossini G, Montali F, Lippi G, Cervellin G. Prognostic value of the OESIL risk score in a cohort of Emergency Department patients with syncope. Minerva Med. 2013 Aug;104(4):413-9.
  6. Baranchuk A, McIntyre W, Harper W, Morillo CA. Application Of The American College Of Emergency Physicians (ACEP) Recommendations And a Risk Stratification Score (OESIL) For Patients With Syncope Admitted From The Emergency Department. Indian Pacing Electrophysiol J. 2011 Sep;11(5):134-44. Epub 2011 Oct 2.