FAINT Score

Dr. Emil Klosowiak


Not done going to trim and add pictures- OL

Background

Syncopal/pre-syncopal episodes represent over 1 million emergency department visits each year.1 However, about half of these visits have a workup that does not reveal a clear etiology of the episode. This can create a dilemma in disposition of patients, particularly elderly patients who are higher risk for recurrence and secondary injury.

Article

Probst, Marc A., et al. "Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score." Annals of emergency medicine 75.2 (2020): 147-158.

Study Design

The researchers conduced a prospective, observational study of older adults (>60 years) with unexplained syncope or near syncope who presented to 11 US Emergency Departments (ED). The study excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data was collected for all subjects which included N-terminal pro B-type natriuretic peptide (NT- proBNP) and fifth-generation high-sensitivity cardiac troponin T (hs-cTnT). The primary outcome was 30-day all-cause mortality or serious cardiac outcome. In addition, electronic medical records were reviewed at 30 days post initial encounter, as well as a telephone call to subjects to ascertain out-of-hospital deaths, ED visits or other hospitalizations. Initial ECGs were assessed by one of five physicians who were blinded to all other clinical data.

Results

The incidence of the primary outcome at 30 days was 5.7% Using Bayesian logistic regression, the researchers derived the FAINT score.

  • FAINT score: 0 vs ≥1

    • sensitivity of 96.7% (95% CI 92.9% to 98.8%)

    • specificity 22.2% (95% CI 20.7% to 23.8%)


  • The FAINT score “tended” to be more accurate than unstructured physician judgment, but the 95% CI overlapped.

    • 0.704 (95% CI 0.669 to 0.739) (FAINT)

    • 0.630 (95% CI 0.589 to 0.670) (physician)


Study participants were reclassified retrospectively based on the FAINT score.


  • Correctly reclassified patients was 466 of 3,174 (14.68%)

    • 11 who were FAINT score positive, were discharged, and had a serious outcome

    • 455 who were FAINT score negative, were hospitalized , and did not have a serious outcome

  • Incorrectly reclassified patients was 456 of 3,174 (14.37%),

    • 450 who were FAINT score positive, without a serious outcome and were discharged

    • 6 who were FAINT score negative, were admitted by the treating physician with a serious outcome.

Net reclassification improvement of 0.31% favoring the FAINT score (Clinically Significant?).




Conclusion/Bomb and Application


FAINT score was derived to assist with disposition of 60+ year old patients who present with syncope/pre-syncope of unknown etiology.

  • Reclassification showed mild statistically significant improvement of disposition based on the FAINT score (0.31%), but this does not appear to be very clinically significant

  • Well conducted study: prospective, large, multicenter

  • Requires two assays not readily available in all Eds, hs-cTnT, NT- proBNP

  • Not yet externally validated

  • Not significantly better than unstructured physician disposition

  • FAINT score of zero had a reasonably high sensitivity

  • Does it currently change Clinical Practice? No, not clinically significant and not externally validated