CLINICAL STUDY
Historical criteria that distinguish syncope from seizures
Robert Sheldon, MD, PhD*,*,
Sarah Rose, PhD*,
Debbie Ritchie, MN*,
Stuart J. Connolly, MD ,
Mary-Lou Koshman, RN*,
Mary Anne Lee, MD ,
Michael Frenneaux, MD ,
Michael Fisher, BSc* and
William Murphy, MD
* 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.
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Abbreviations and Acronyms
| | ECG | | electrocardiogram/electrocardiograph | | EEG | | electroencephalogram | | IQR | | interquartile range | | ROC | | receiver-operating characteristic | | VT | | ventricular tachycardia |
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