Seizure or syncope: Is the history-based scale feasible to use in an emergency department setting?

Stevo Lukić; Aleksandar Stojanov

doi:10.1016/j.auec.2023.11.002

Seizure or syncope: Is the history-based scale feasible to use in an emergency department setting?

Australas Emerg Care. 2023 Dec 5:S2588-994X(23)00089-1. doi: 10.1016/j.auec.2023.11.002. Online ahead of print.

Authors

Stevo Lukić¹, Aleksandar Stojanov²

Affiliations

¹ Clinic of Neurology, University Clinical Centre Niš, Serbia; Faculty of Medicine, University of Niš, Serbia. Electronic address: slukic@medfak.ni.ac.rs.
² Clinic of Neurology, University Clinical Centre Niš, Serbia; Faculty of Medicine, University of Niš, Serbia.

PMID: 38057243
DOI: 10.1016/j.auec.2023.11.002

Abstract

Background: This study aimed to assess the efficacy of a screening questionnaire, based on historical criteria, in distinguishing between seizures and syncope in patients experiencing their first episode of transient loss of consciousness (TLOC) in a neurology emergency department.

Methods: A prospective cohort of 159 patients with initial TLOC episodes underwent clinical observation and answered a nine-question screening questionnaire. The questionnaire's predictive ability was compared to final diagnoses determined through detailed neurology, electrophysiology, and cardiology assessments during a minimum 12-month follow-up. Logistic regression (LR) analysis was performed with final diagnosis as the outcome variable. The calibration and discrimination of the models were assessed.

Results: revealed that the screening score accurately classified 72.33% of patients. Among those with positive screening scores, 65 (67.71%) had seizures compared to 31 (32.29%) with syncope. Introducing a novel risk-scoring model incorporating age and gender, in addition to the screening score, significantly improved performance achieving an accurate classification rate of 81.48%. Among patients with a positive prediction, 63 (80.77%) had seizure, whereas 15 (19.23%) had syncope.

Conclusions: Employing a structured questionnaire based on common historical criteria is a valuable tool for distinguishing between seizure and syncope in the dynamic setting of the emergency department.

Keywords: Differential diagnosis; Seizure; Syncope; Transient loss of consciousness.