Annals of Emergency Medicine
Volume 47, Issue 5 , Pages 448-454 , May 2006

Prospective Validation of the San Francisco Syncope Rule to Predict Patients With Serious Outcomes

Presented at the Society for Academic Emergency Medicine annual meeting, May 2004, Orlando, FL.

  • James Quinn, MD, MS

      Affiliations

    • Division of Emergency Medicine, Stanford University, Palo Alto, CA
    • Corresponding Author InformationAddress for correspondence: James Quinn, MD, MS, Division of Emergency Medicine, Stanford University, 701 Welch Rd, Suite C103, Palo Alto, CA 94304; 650-736-4391, fax 650-723-0121
    • ,
  • Daniel McDermott, MD

      Affiliations

    • Department of Medicine, University of California-San Francisco, San Francisco, CA
    • ,
  • Ian Stiell, MD, MSc

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
    • ,
  • Michael Kohn, MD, MPP

      Affiliations

    • Department of Medicine, University of California-San Francisco, San Francisco, CA
    • ,
  • George Wells, PhD

      Affiliations

    • Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada

Received 20 October 2005 ,Revised 1 November 2005 ,Accepted 7 November 2005.

References 

  1. Wayne NN . Syncope (physiological considerations and an analysis of the clinical characteristics in 510 patients) . Am J Med. . 1961;30:418–438
  2. Kapoor WN , Karpf M , Wieand S , et al.   A prospective evaluation and follow-up of patients with syncope . N Engl J Med. . 1983;309:197–204
  3. Soteriades ES , Evans JC , Larson MG , et al.   Incidence and prognosis of syncope . N Engl J Med. . 2002;347:878–885
  4. Quinn JV , Stiell IG , McDermott DA , et al.   Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes . Ann Emerg Med. . 2004;43:224–232
  5. Maisel WH , Stevenson WG . Syncope (getting to the heart of the matter) . N Engl J Med. . 2002;347:931–933
  6. Diaz-Castro O , Puchol A , Almendral J , et al.   Predictors of in-hospital ventricular fibrillation or torsades de pointes in patients with acute symptomatic bradycardia . J Electrocardiol. . 2004;37:55–60
  7. Wolfe TR , Allen TL . Syncope as an emergency department presentation of pulmonary embolism . J Emerg Med. . 1998;16:27–31
  8. Bass EB , Elson JJ , Fogoros RN , et al.   Long-term prognosis of patients undergoing electrophysiologic studies for syncope of unknown origin . Am J Cardiol. . 1988;62:1186–1191
  9. Georgeson S , Linzer M , Griffith JL , et al.   Acute cardiac ischemia in patients with syncope (importance of the initial electrocardiogram) . J Gen Intern Med. . 1992;7:379–386
  10. Gallagher EJ . Hospitalization for fainting (high stakes, low yield) . Ann Emerg Med. . 1997;29:540–542
  11. Sun BC , Emond JA , Camargo CA . Direct medical costs of syncope-related hospitalizations in the United States . Am J Cardiol. . 2005;95:668–671
  12. Brignole M , Alboni P , Benditt DG , et al.   Guidelines on management (diagnosis and treatment) of syncope: update 2004: executive summary . Eur Heart J. . 2004;25:2054–2072
  13. American College of Emergency Physicians . Clinical policy (critical issues in the evaluation and management of patients presenting with syncope) . Ann Emerg Med. . 2001;37:771–776
  14. Linzer M , Yang EH , Estes NA , et al.   Diagnosing syncope, part 2: unexplained syncope: clinical efficacy assessment project of the American College of Physicians . Ann Intern Med. . 1997;127:76–86
  15. Linzer M , Yang EH , Estes NA , et al.   Diagnosing syncope, part 1: value of history, physical examination, and electrocardiography: crlinical efficacy assessment project of the American College of Physicians . Ann Intern Med. . 1997;126:989–996
  16. Schillinger M , Domanovits H , Mullner M , et al.   Admission for syncope (evaluation, cost and prognosis) . Wien Klin Wochenschr . 2000;112:835–841
  17. Quinn J , McDermott D , Kohn M , et al.   Admission for low risk patients with syncope . [abstract] Acad Emerg Med. . 2005;12:126–127
  18. Crane SD . Risk stratification of patients with syncope in an accident and emergency department . Emerg Med J. . 2002;19:23–27
  19. Zaidi AM , Fitzpatrick AP . Investigation of syncope (increasing the yield and reducing the cost) . Eur Heart J. . 2000;21:877–880
  20. von Dohlen TW , Frank MJ . Presyncope and syncope (how to find the cause and avoid staggering costs) . Postgrad Med. . 1989;86:85–88 91, 94-96
  21. Mozes B , Confino-Cohen R , Halkin H . Cost-effectiveness of in-hospital evaluation of patients with syncope . Isr J Med Sci. . 1988;24:302–306
  22. Bogden PE . A more cost-effective evaluation of syncope . Hawaii Med J. . 1985;44:340–344
  23. Kapoor WN , Karpf M , Maher Y , et al.   Syncope of unknown origin (the need for a more cost-effective approach to its diagnosis evaluation) . JAMA . 1982;247:2687–2691
  24. Bartoletti A , Fabiani P , Gianni R , et al.   After the 2001 European Society of Cardiology guidelines (is it possible to reduce the number of patients with syncope to be hospitalized?) . Minerva Med. . 2004;95:451–460
  25. Stiell IG , Wells GA . Methodologic standards for the development of clinical decision rules in emergency medicine . Ann Emerg Med. . 1999;33:437–447
  26. Quinn J , Durski K . A real-time tracking, notification, and web-based enrollment system for emergency department research . Acad Emerg Med. . 2004;11:1245–1248
  27. Blanc JJ , L’Her C , Touiza A , et al.   Prospective evaluation and outcome of patients admitted for syncope over a 1 year period . Eur Heart J. . 2002;23:815–820
  28. Pires LA , Ganji JR , Jarandila R , et al.   Diagnostic patterns and temporal trends in the evaluation of adult patients hospitalized with syncope . Arch Intern Med. . 2001;161;:1889–1895
  29. Del Greco M , Cozzio S , Scillieri M , et al.   Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital (the ECSIT study (epidemiology and costs of syncope in Trento)) . Ital Heart J. . 2003;4:99–106
  30. Morag RM , Murdock LF , Khan ZA , et al.   Do patients with a negative emergency department evaluation for syncope require hospital admission? . J Emerg Med. . 2004;27:339–343
  31. Stiell IG , Wells GA , Vandemheen KL , et al.   The Canadian C-spine rule for radiography in alert and stable trauma patients . JAMA . 2001;286:1841–1848
  32. Thakore SB , Crombie I , Johnston M . The management of syncope in a British emergency department compared to recent American guidelines . Scott Med J. . 1999;44:155–157
  33. Farwell DJ , Sulke AN . Does the use of a syncope diagnostic protocol improve the investigation and management of syncope? . Heart . 2004;90:52–58
  34. Martin TP , Hanusa BH , Kapoor WN . Risk stratification of patients with syncope . Ann Emerg Med. . 1997;29:459–466
  35. Colivicchi F , Ammirati F , Melina D , et al.   Development and prospective validation of a risk stratification system for patients with syncope in the emergency department (the OESIL risk score) . Eur Heart J. . 2003;24:811–819
  36. Sarasin FP , Hanusa BH , Perneger T , et al.   A risk score to predict arrhythmias in patients with unexplained syncope . Acad Emerg Med. . 2003;10:1312–1317
  37. Middlekauff HR , Stevenson WG , Saxon LA . Prognosis after syncope (impact of left ventricular function) . Am Heart J. . 1993;125:121–127
  38. Middlekauff HR , Stevenson WG , Stevenson LW , et al.   Syncope in advanced heart failure (high risk of sudden death regardless of origin of syncope) . J Am Coll Cardiol. . 1993;21:110–116
  39. Laupacis A , Sekar N , Stiell I . Clinical prediction rules (a review and suggested modifications of methodological standards) . JAMA . 1997;277:488–494
  40. Quinn JV , Stiell IG , McDermott DA , et al.   San Francisco Syncope Rule vs. physician judgment and decision making . Am J Emerg Med. . 2005;23:782–786
  41. Elesber AA , Decker WW , Smars PA , et al.   Impact of the application of the American College of Emergency Physicians recommendations for the admission of patients with syncope on a retrospectively studied population presenting to the emergency department . Am Heart J. . 2005;149:826–831

 Supervising editor: Judd E. Hollander, MDAuthor contributions: JQ, IS, and GW conceived and designed the trial. JQ, DM, and MK supervised the conduct of the trial and data collection and provided database management and quality control. JQ, IS, MK, and GW contributed to the statistical analysis with advice, with JQ and IS doing the primary analysis. JQ drafted the manuscript, with all authors contributing significantly to its revisions. JQ takes responsibility for the paper as a whole.Funding and support: JQ is funded through a career development grant from the National Institutes of Health, K23, AR002137-050.Reprints not available from the authors.

PII: S0196-0644(05)01959-1

doi: 10.1016/j.annemergmed.2005.11.019

Annals of Emergency Medicine
Volume 47, Issue 5 , Pages 448-454 , May 2006

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