Annals of Emergency Medicine
Volume 52, Issue 2 , Pages 151-159 , August 2008

Failure to Validate the San Francisco Syncope Rule in an Independent Emergency Department Population

Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2007, Chicago, IL.

Received 20 June 2007 ,Revised 30 October 2007 ,Accepted 3 December 2007.

References 

  1. 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
  2. Sun BC, Emond JA, Camargo CA. Characteristics and admission patterns of patients presenting with syncope to US emergency departments, 1992-2000. Acad Emerg Med. 2004;11:1029–1034
  3. Sun BC, Emond JA, Camargo CA. Direct medical costs of syncope-related hospitalizations in the United States. Am J Cardiol. 2005;95:668–671
  4. Gallagher EJ. Hospitalization for fainting: high stakes, low yield. Ann Emerg Med. 1997;29:540–542
  5. Kapoor WN. Syncope. N Engl J Med. 2000;343:1856–1862
  6. 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
  7. Quinn J, McDermott D, Stiell I, et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006;47:448–454
  8. Sun BC, Mangione CM, Merchant G, et al. External validation of the San Francisco Syncope Rule. Ann Emerg Med. 2007;49:420–427
  9. Quinn JV. In reply (Thirty-day versus 7-day outcomes in the San Francisco Syncope Rule). Ann Emerg Med. 2006;48:760
  10. Feinstein AR, Cicchetti DV. High agreement but low kappa: I (The problems of two paradoxes). J Clin Epidemiol. 1990;43:543–549
  11. Stiell IG, Wells GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med. 1999;33:437–447
  12. Gallagher EJ. Shooting an elephant. Ann Emerg Med. 2004;43:233–237
  13. Wasson JH, Sox HC, Neff RK, et al. Clinical prediction rules: application and methodologic standards. N Engl J Med. 1985;313:793–799
  14. Charlson ME, Ales KL, Simon R, et al. Why predictive indexes perform less well in validation studies. Arch Intern Med. 1987;147:2155–2161
  15. Poses RM, Cebul RD, Collins M, et al. The importance of disease prevalence in transporting clinical prediction rules: the case of streptococcal pharyngitis. Ann Intern Med. 1986;105:586–591
  16. Wigton RS, Connor JL, Centor RM. Transportability of a decision rule for the diagnosis of streptococcal pharyngitis. Arch Intern Med. 1986;146:81–83
  17. Gallagher EJ. Clinical utility of likelihood ratios. Ann Emerg Med. 1998;31:391–397
  18. Griffith J. Artificial neural networks: are they ready for use as clinical decision aids?. Med Decis Makings. 2000;20:243

 Supervising editor: Robert Silbergleit, MD

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Author contributions: AB, DE, PB, and EJG conceived the study and designed the trial. DE and AW supervised the conduct of the trial and data collection. AB, DE, and AW managed the data, including quality control. PB provided statistical advice on study design and data analysis. AB analyzed the data. AB drafted the article, and all authors contributed substantially to its revision. AB takes responsibility for the paper as a whole.

 Publication dates: Available online February 20, 2008.

 Reprints not available from the authors.

PII: S0196-0644(07)01858-6

doi: 10.1016/j.annemergmed.2007.12.007

Annals of Emergency Medicine
Volume 52, Issue 2 , Pages 151-159 , August 2008

Article Tools

* Image Usage & Resolution