OESIL Score for Syncope

Why did you develop the OESIL Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

I had been practicing emergency medicine for more than five years before moving to clinical cardiology. As for most practicing physicians, in those long and challenging years, the risk stratification of patients with syncope in the emergency room has always been particularly difficult for me. Besides, I can certainly remember several patients in whom the final outcome resulted just far from what I had initially imagined. Therefore, with the help of some experienced fellow clinicians, I tried to define how clinical and electrocardiographic data readily available at presentation in the emergency department could be used for the risk stratification of patients with syncope.

What pearls, pitfalls and/or tips do you have for users of the OESIL Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

The OESIL Score is simple and it can be easily applied in almost all cases, even at the moment of the very initial presentation in the emergency room. In my own opinion, this represents an interesting opportunity in clinical practice. However, you have to bear in mind that it stratifies syncope patients for one-year total mortality. Consequently, it provides the clinician with a sort of “general picture.” Therefore, when considering a specific patient, you then have to fill the overall frame with the particulars. That is to say, that it could possibly be not fully effective in predicting very short-term adverse events in some cases. However, the OESIL Score has been considered and further validated in several clinical studies in different countries. There are about 18 references in PubMed. In almost all of those clinical experiences the OESIL Score proved effective and fairly useful for clinical decision-making, while it is currently considered as "one of the best performing syncope-specific risk score" (du Fay de Lavallaz 2018).

What recommendations do you have for doctors once they have applied the OESIL Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

I do think that, even after more than 15 years, the OESIL Score can still have a role in clinical practice. However, it should always be used as a support to clinical judgment. In all cases, the clinician should integrate the score with any other potentially useful information from any source, including, just for a start, physical examination and blood chemistry. 

How do you use the OESIL Score in your own clinical practice? Can you give an example of a scenario in which you use it?

In my institution, the OESIL Score is currently used as a decision aid tool for hospital admission triage. Patients with a score of 2 or more are usually admitted for clinical monitoring and further diagnostic evaluation. Patients with a score of 0-1 are usually referred to the out-patient department for further clinical work-up. This approach has generally proven safe and effective in reducing unnecessary admissions.

Any comment on similar scores like the San Francisco Syncope Rule?

The San Francisco Syncope Rule is effective in predicting short-term serious outcomes in patients presenting with syncope in the emergency department. In particular, it was developed in order to determine whether syncope patients could experience a major adverse event within 7 days of their initial emergency department visit. When compared with the OESIL Score, the San Francisco Score relies on a different set of information, including "acute" abnormalities, such as shortness of breath, hematocrit less than 30% and systolic blood pressure less than 90 mm Hg. In general, we can think the two scores may integrate, possibly being used in rapid sequence. First, consider the San Francisco Rule in order to detect syncope patients with a significant risk of almost immediate negative outcome (for example hemorrhagic emergencies). Subsequently, refine the assessment in stable patients (the vast majority) with the OESIL Score for medium-term risk stratification.

Is there any research you're working on that you're particularly excited about?

I am currently working on risk stratification in atrial fibrillation.

Furio Colivicchi, MD, is a practicing cardiologist in Rome, Italy. He is Director of Cardiology at San Filippo Neri Hospital. Dr. Colivicchi’s research interests include syncope risk stratification and the use of statins in acute coronary syndrome.