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FAINT Score – Who Needs Admission For Syncope?

January 2, 2020

Written by Aaron Lacy

Spoon Feed
For elderly patients presenting after syncope, the FAINT Score, a 5-variable risk score, predicted serious 30-day outcomes, although the rule has not had external validation.

Why does this matter?
Syncope is common and potentially serious. There has yet to be a risk stratification tool that has gained widespread adoption or validation, making disposition challenging. We covered use of biomarkers for syncope risk stratification earlier as standalone predictors. How would using biomarkers as part of a broader risk score fare?

Torturing acrostics is inhumane…
This was a prospective, observational study of 3,177 adults over the age of 60 with unexplained syncope or near syncope from 11 EDs in the U.S. Patients with a newly identified serious diagnosis were excluded. The authors used Bayesian logistic regression to derive the variables and came up with the tortured acrostic: the FAINT Score:

F: Heart failure (1 point)
A: Cardiac arrhythmia (1 point)
I: Initial abnormal EKG (1 point)
N: elevated B-type natriuretic peptide (2 points)
T: elevated high sensitivity troponin T (1 point)

A FAINT score of 0 versus ≥1 had a sensitivity of 96.7% (95 CI 92.9-98.8%) and specificity 22.2% (95% CI 20.7-23.8%) for excluding death and serious cardiac outcomes at 30 days. The FAINT score was almost more accurate than unstructured physician judgment (AUC 0.704 vs 0.630). I will not be using the FAINT score, as it has yet to be externally validated and uses two high sensitivity biomarkers (NT-proBNP and hs-cTnT) not readily available in all emergency departments. However, it is simple and uses practical variables, and it will be interesting to see if it holds up to external validation, unlike so many of its predecessors.

Another Spoonful
Check out this podcast by Emergency Medicine Cases for a thorough review of literature on adult and pediatric syncope.

Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score. Ann Emerg Med. 2019 Oct 23. pii: S0196-0644(19)31113-8. doi: 10.1016/j.annemergmed.2019.08.429. [Epub ahead of print]

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What are your thoughts?