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

EGSYS Score
Palpitations before syncope
Abnormal ECG and/or heart disease
Syncope during effort
Syncope while supine
Autonomic prodromes (nausea, warmth)
Predisposing/precipitating factors (crowded/warm place, prolonged standing, fear/pain)
EGSYS Score:0
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Predicts likelihood that syncope is from cardiac cause.

Why Use

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

When to Use

Patients presenting to the emergency department with syncope.

Formula

Addition of the selected points: Finding Points Abnormal EKG 1 and/or heart disease 2 +3 Palpitations before syncope +4 Syncope during effort +3 Syncope in supine position +2 Autonomic prodromes 3 -1 Predisposing and/or precipitating factors 4 -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. 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. Nausea/vomiting. Warm or crowded place, prolonged orthostasis, fear/pain/other emotion.

Pearls / Pitfalls

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%).

Critical Actions

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

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.

More Information

Interpretation: EGSYS Interpretation Mortality at 21–24 months ≥3 Cardiac syncope likely (95% sensitive) 17% <3 Cardiac syncope less likely 3%

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