Operative characteristics of the STePS prediction rule for short-term serious outcomes in patients with syncope

Abstract

Introduction: syncope is a common clinical condition in the emergency room with a variable prognosis depending on its etiology. The STePS study identified four variables which were independently related to serious outcomes within 10 days. The objective of the study was to evaluate its performance in a population of patients seen in the emergency room for syncope.

Methods: a prospective observational study of patients seen in the emergency room of the Hospital Universitario Clínica San Rafael with a diagnosis of syncope. A descriptive analysis of the population"(TM)s demographic and clinical variables was conducted, along with a comparative analysis according to admission or non-admission to the ICU. Qualitative and quantitative variables were analyzed using Chi-square or Student"(TM)s t test, respectively. The operative characteristics of the STePS rule were evaluated in a graph, with an area under the curve (AUC) greater than 0.8 considered to be acceptable, and greater than 0.9 considered to be optimal.

Results: Ninety-eight patients were included. The performance of the STePS prediction rule was AUC-ROC 0.64 (95% CI; 0.53-0.75). Only an abnormal electrocardiogram (OR 13.98, 95% CI 1.29-151.9) and concomitant trauma (OR 5.22, 95% CI 1.20-22.67) proved to be risk factors for serious outcomes within 10 days. Prevalent factors in the population admitted to the ICU were: age >65 years (p=0.02), a history of heart failure (p=0.047), chronic kidney disease (p=0.002) and heart disease (p=0.01).

Conclusion: the STePS prediction rule did not perform favorably for predicting serious outcomes within 10 days of the syncopal event in this study population.