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; received in revised form 1 November 2005; accepted 7 November 2005. published online 17 January 2006.

Study objective

We prospectively validate the San Francisco Syncope Rule (history of congestive heart failure, Hematocrit <30%, abnormal ECG result [new changes or non–sinus rhythm], complaint of shortness of breath, and systolic blood pressure <90 mm Hg during triage).

Methods

In a prospective cohort study, consecutive patients with syncope or near syncope presenting to an emergency department (ED) of a teaching hospital were identified and enrolled from July 15, 2002, to August 31, 2004. Patients with trauma, alcohol, or drug-associated loss of consciousness and definite seizures were excluded. Physicians prospectively applied the San Francisco Syncope Rule after their evaluation, and patients were followed up to determine whether they had had a predefined serious outcome within 30 days of their ED visit.

Results

Seven hundred ninety-one consecutive visits were evaluated for syncope, representing 1.2% of all ED visits. The average age was 61 years, 54% of patients were women, and 59% of patients were admitted. Fifty-three visits (6.7%) resulted in patients having serious outcomes that were undeclared during their ED visit. The rule was 98% sensitive (95% confidence interval [CI] 89% to 100%) and 56% specific (95% CI 52% to 60%) to predict these events. In this cohort, the San Francisco Syncope Rule classified 52% of the patients as high risk, potentially decreasing overall admissions by 7%. If the rule had been applied only to the 453 patients admitted, it might have decreased admissions by 24%.

Conclusion

The San Francisco Syncope Rule performed with high sensitivity and specificity in this validation cohort and is a valuable tool to help risk stratify patients. It may help with physician decisionmaking and improve the use of hospital admission for syncope.

 

 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

Refers to article:

  • Prospective Validation of the San Francisco Syncope Rule: Will It Change Practice? , 17 January 2006

    Chadwick D. Miller, James W. Hoekstra
    Annals of Emergency Medicine May 2006 (Vol. 47, Issue 5, Pages 455-456)

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