An adapted FAINT score shows high sensitivity but modest overall discrimination when predicting short-term adverse events in older adults presenting to the emergency department with syncope, according to a single-center retrospective cohort study published on November 8, 2026, in Cureus by N. Haris, S. Menon, and L. ATK.
Assessing Clinical Risk in Emergency Rooms
- The parent cohort reviewed 350 patient records from 2018 to 2019, though complete data for all five adapted FAINT variables narrowed the final analysis down to 144 patients aged 65 and older.
- Adverse events occurred in 11.8% of patients within 48 hours and 23.6% within 30 days, tracking outcomes like death, major cardiovascular or cerebrovascular events, procedural interventions, or return ED visits.
- Researchers noted that while the tool reliably flags low-risk patients due to a 100% sensitivity rate at 48 hours, its modest overall discrimination means it serves better as a clinical adjunct than an independent tool for determining safe ED discharge.
Evaluating the Adapted FAINT Score
Risk stratification for older adults experiencing transient loss of consciousness remains a distinct hurdle in emergency medicine. Haris et al. examined whether an adapted version of the FAINT score could accurately predict short-term adverse outcomes in patients aged 65 and older. Because N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin assays were unavailable in the retrospective dataset, the authors substituted brain natriuretic peptide (>100pg/ml) and conventional troponin.
Among the 144 complete-case patients analyzed, adverse events materialized in 17 individuals within 48 hours. None of these early events occurred in patients classified as low-risk by the score, yielding a 100% sensitivity rate for that timeframe. By 30 days, adverse events touched 34 patients, with only two occurring in the low-risk bracket.
Study Shows Fair Discrimination Despite Single-Center Limitations
The study reported area under the receiver operating characteristic curve values of 0.691 for 48-hour outcomes and 0.693 for 30-day outcomes. These metrics point to fair overall discrimination despite high sensitivity and negative predictive values. The authors cautioned that these findings stem from a single-center retrospective design with notable exclusions due to missing biomarker data.
| Metric / Timeframe | 48-Hour Outcomes | 30-Day Outcomes |
|---|---|---|
| Adverse Event Rate | 11.8% (n=17) | 23.6% (n=34) |
| Low-Risk Event Rate | 0.0% (n=0) | 8.7% (n=2) |
| High-Risk Event Rate | 14.0% (n=17) | 26.4% (n=32) |
| Sensitivity | 100% | 94.1% |
| AUC Discrimination | 0.691 | 0.693 |
Within this group of patients, the modified FAINT tool exhibited strong negative predictive value and high sensitivity alongside limited overall performance in differentiation. The results indicate that the instrument may serve usefully alongside medical evaluation rather than standing alone to decide when emergency department patients can be safely sent home.
Because of the reliance on complete cases, altered biomarkers, and a wider composite endpoint than the initial research, further validation via larger, prospective, multi-site investigations is necessary.
