a clinical score for predicting the paroxysmal supraventricular tachycardia’s recurrence risk; a retrospective cross-sectional study

Introduction: identifying prognostic variables associated with the probability of recurrent paroxysmal supraventricular tachycardia (psvt) would aid decision-making regarding disposition of the patients. this study aims to develop a clinical scoring system to predict psvt recurrence after adenosine administration in the emergency department (ed).methods: this retrospective cross-sectional study was conducted on patients who were referred to the emergency department of ramathibodi hospital, a university-affiliated super-tertiary care hospital in bangkok, thailand, with diagnosis of psvt during a 10-year period from 01 january 2010 until 31 december 2020. the cases were divided into recurrent and non-recurrent psvt based on the response to standard treatment and the independent predictors of recurrence were studied using multivariable logistic regression analysis. results: 264 patients were diagnosed with psvt and successfully converted by adenosine. 24 (9.1%) had recurrent psvt, and 240 (90.9%) had no recurrent psvt in the same ed visit. the risk of psvt recurrence in ed corresponded with the history of hypertension (p = 0.059), valvular heart disease (p = 0.052), heart rate ≥ 100 (p = 0.012), and systolic blood pressure < 100 after electrocardiogram (ecg) converted to sinus rhythm (p = 0.022) and total dose of adenosine (p = 0.002). we developed a clinical prediction score of psvt recurrence with an accuracy of 79.5%. a score of 0 (low risk), 1–2 (moderate risk), and > 2 (high risk) had a positive likelihood ratio (lr+) of 0.31, 0.56 and 2.33, respectively. conclusion: it seems that, using the psvt recurrence score we could screen the high-risk patients for psvt recurrence (score>2) who need to be observed for at least 6-12 hours and receive cardiologist consultation in ed. in addition, the moderate and low-risk group (score 0-2) need to be observed for 1 hour and can be discharged from ed.