|
|
||||||||||
|
J Am Coll Cardiol, 2002; 40:142-148 © 2002 by the American College of Cardiology Foundation |




* Cardiovascular Research Group, University of Calgary, Calgary, Alberta, Canada
McMaster University, Hamilton, Ontario, Canada
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Wales Heart Research Institute, Cardiff, Wales, United Kingdom
Manuscript received February 15, 2002; revised manuscript received March 25, 2002, accepted April 4, 2002.
* Reprint requests and correspondence: Dr. Robert Sheldon, Cardiovascular Research Group, University of Calgary, 3330 Hospital Drive NW, Calgary,Alberta T2N 4N1, Canada.
sheldon{at}ucalgary.ca
OBJECTIVES: We prospectively sought evidence-based criteria that distinguished between seizures and syncope.
BACKGROUND: Loss of consciousness is usually due to either seizures or syncope. There are no evidence-based historical diagnostic criteria that distinguish them.
METHODS: A total of 671 patients with loss of consciousness completed a 118-item historical questionnaire. Data sets were complete for all subjects. The data set was randomly divided into two equal groups. The contributions of symptoms to diagnoses in one group were estimated with logistic regression and point scores were developed. The accuracy of the decision rule was then assessed using split-half analysis. Analyses were performed with and without inclusion of measures of symptom burden, which were the number of losses of consciousness and the duration of the history. The scores were tested using receiver-operator characteristic analysis.
RESULTS: The causes of loss of consciousness were known satisfactorily in 539 patients and included seizures (n = 102; complex partial epilepsy [50 patients] and primary generalized epilepsy [52 patients]) and syncope (n = 437; tilt-positive vasovagal syncope [267 patients], ventricular tachycardia [90 patients] and other diagnoses such as complete heart block and supraventricular tachycardias [80 patients]). The point score based on symptoms alone correctly classified 94% of patients, diagnosing seizures with 94% sensitivity and 94% specificity. Including symptom burden did not significantly improve accuracy, indicating that the symptoms surrounding the loss of consciousness accurately discriminate between seizures and syncope.
CONCLUSIONS: A simple point score of historical features distinguishes syncope from seizures with very high sensitivity and specificity.
| ||||||||||||
This article has been cited by other articles:
![]() |
S. Petkar and A. Fitzpatrick Tilt-table testing: transient loss of consciousness discriminator or epiphenomenon? Europace, June 1, 2008; 10(6): 747 - 750. [Full Text] [PDF] |
||||
![]() |
R. Duara, S. Shekhar Padhi, A. Padmanabhan Iyer, C. Parija, and S. Rema Krishna Manohar Convulsive syncope after bidirectional Glenn shunts: physiological implications for a neurological event Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 594 - 598. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Petkar, P. Cooper, and A. P Fitzpatrick How to avoid a misdiagnosis in patients presenting with transient loss of consciousness. Postgrad. Med. J., October 1, 2006; 82(972): 630 - 641. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Serletis, S. Rose, A. G. Sheldon, and R. S. Sheldon Vasovagal syncope in medical students and their first-degree relatives Eur. Heart J., August 2, 2006; 27(16): 1965 - 1970. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Sheldon, S. Rose, S. Connolly, D. Ritchie, M.-L. Koshman, M. Frenneaux, and for the Syncope Symptom Study Investigators Diagnostic criteria for vasovagal syncope based on a quantitative history Eur. Heart J., February 1, 2006; 27(3): 344 - 350. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. A. Strickberger, D. W. Benson, I. Biaggioni, D. J. Callans, M. I. Cohen, K. A. Ellenbogen, A. E. Epstein, P. Friedman, J. Goldberger, P. A. Heidenreich, et al. AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With the Heart Rhythm Society J. Am. Coll. Cardiol., January 17, 2006; 47(2): 473 - 484. [Full Text] [PDF] |
||||
![]() |
S. A. Strickberger, D. W. Benson, I. Biaggioni, D. J. Callans, M. I. Cohen, K. A. Ellenbogen, A. E. Epstein, P. Friedman, J. Goldberger, P. A. Heidenreich, et al. AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: In Collaboration With the Heart Rhythm Society: Endorsed by the American Autonomic Society Circulation, January 17, 2006; 113(2): 316 - 327. [Full Text] [PDF] |
||||
![]() |
C M Gavin and J T Gray 15 Assessment and management of neurological problems (2) Emerg. Med. J., August 1, 2005; 22(8): 564 - 571. [Full Text] [PDF] |
||||
![]() |
J D C Mellers The approach to patients with "non-epileptic seizures" Postgrad. Med. J., August 1, 2005; 81(958): 498 - 504. [Abstract] [Full Text] [PDF] |
||||
![]() |
Task Force members, M. Brignole, P. Alboni, D. G. Benditt, L. Bergfeldt, J.-J. Blanc, P. E. B. Thomsen, J. G. van Dijk, A. Fitzpatrick, S. Hohnloser, et al. Guidelines on management (diagnosis and treatment) of syncope - Update 2004: The task force on Syncope, European Society of Cardiology Eur. Heart J., November 2, 2004; 25(22): 2054 - 2072. [Full Text] [PDF] |
||||
![]() |
C T P Krediet, D L Jardine, P Cortelli, A G R Visman, and W Wieling Vasovagal syncope interrupting sleep? Heart, May 1, 2004; 90(5): e25 - e25. [Abstract] [Full Text] [PDF] |
||||
![]() |
Guidelines on Management (diagnosis and treatment) of syncope - update 2004: The Task Force on Syncope, European Society of Cardiology Europace, January 1, 2004; 6(6): 467 - 537. [Full Text] [PDF] |
||||
![]() |
Syncope vs. Seizures: Value of Clinical History Journal Watch Pediatrics and Adolescent Medicine, December 6, 2002; 2002(1206): 15 - 15. [Full Text] |
||||
![]() |
Syncope vs. Seizures: Value of Clinical History Journal Watch Cardiology, August 30, 2002; 2002(830): 3 - 3. [Full Text] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |