Annals of Emergency Medicine
Volume 55, Issue 5 , Pages 464-472 , May 2010

External Validation of the San Francisco Syncope Rule in the Canadian Setting

  • Venkatesh Thiruganasambandamoorthy, MBBS, MSc

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • Corresponding Author InformationAddress for correspondence: Venkatesh Thiruganasambandamoorthy, MBBS, MSc, Ottawa Health Research Institute, Clinical Epidemiology Unit, The Ottawa Hospital, Civic Campus, 1053 Carling Ave, 6th Floor, Rm F655, Ottawa, Ontario K1Y 4E9, Canada; 613-798-5555 ext. 17023, fax 613-761-5351
    • ,
  • Erik P. Hess, MD, MSc

      Affiliations

    • Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, Rochester, MN
    • ,
  • Abdullah Alreesi, MD, MSc

      Affiliations

    • Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman
    • ,
  • Jeffrey J. Perry, MD, MSc

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • George A. Wells, PhD

      Affiliations

    • Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • ,
  • Ian G. Stiell, MD, MSc

      Affiliations

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

Received 16 July 2009 ,Revised 24 September 2009 ,Accepted 1 October 2009.

References 

  1. 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
  2. Sarasin FP, Louis-Simonet M, Carballo D, et al. Prospective evaluation of patients with syncope: a population-based study. Am J Med. 2001;111:177–184
  3. 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
  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. 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
  6. Kapoor WN. Syncope. N Engl J Med. 2000;343:1856–1862
  7. Graham I, Stiell I, McAuley L, et al. Potential areas for new clinical decision rules: comparison of North America and Europe [abstract]. Annu Meet Inc Soc Technol Assess Health Care. 2009;15:
  8. Gallagher EJ. Hospitalization for fainting: high stakes, low yield. Ann Emerg Med. 1997;29:540–542
  9. 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
  10. 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
  11. Kapoor WN, Martin D, Karpf M. Syncope in the elderly: a pragmatic approach. Geriatrics. 1983;38:46–52
  12. 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
  13. Simpson CS, Krahn AD, Klein GJ, et al. A cost effective approach to the investigation of syncope: relative merit of different diagnostic strategies. Can J Cardiol. 1999;15:579–584
  14. Colivicchi F, Ammirati F, Melina D, et al. OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators 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
  15. Martin TP, Hanusa BH, Kapoor WN. Risk stratification of patients with syncope. Ann Emerg Med. 1997;29:459–466
  16. 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
  17. 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
  18. Thiruganasambandamoorthy V, Stiell I, Perry J. Systematic qualitative review of clinical decision rules for syncope in ED for predicting adverse outcomes [poster]. CJEM. 2007;9:214
  19. Quinn JV, Stiell IG, McDermott DA, et al. The San Francisco Syncope Rule vs physician judgment and decision making. Am J Emerg Med. 2005;23:782–786
  20. Birnbaum A, Esses D, Bijur P, et al. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008;52:151–159
  21. Sun BC, Mangione CM, Merchant G, et al. External validation of the San Francisco Syncope Rule. Ann Emerg Med. 2007;49:420–427427.e1-427.e4
  22. Pezzullo JC. Interactive statistics page (2-way contingency table analysis). http://statpages.org/ctab2x2.htmlAccessed November 5, 2009
  23. Gilbert EH, Lowenstein SR, Koziol-McLain J, et al. Chart reviews in emergency medicine research: where are the methods?. Ann Emerg Med. 1996;27:305–308
  24. Worster A, Bledsoe RD, Cleve P, et al. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005;45:448–451
  25. Badcock D, Kelly AM, Kerr D, et al. The quality of medical record review studies in the international emergency medicine literature. Ann Emerg Med. 2005;45:444–447
  26. Lowenstein SR. Medical record reviews in emergency medicine: the blessing and the curse. Ann Emerg Med. 2005;45:452–455
  27. Cosgriff TM, Kelly AM, Kerr D. External validation of the San Francisco Syncope Rule in the Australian context. CJEM. 2007;9:157–161
  28. Reed MJ, Newby DE, Coull AJ, et al. The Risk Stratification of Syncope in the Emergency Department (ROSE) pilot study: a comparison of existing syncope guidelines. Emerg Med J. 2007;24:270–275
  29. Stracner DL, Kass LE. Validation of the San Francisco Syncope Rule. Acad Emerg Med. 2005;12:87–88
  30. Schladenhaufen R, Benenson R, Feilinger S, et al. Application of San Francisco Syncope Rule to elderly emergency department patients. Eur J Emerg Med. 2006;13:A7

 Supervising editor: Allan B. Wolfson, MD

 Author contributions: VT conceived the idea for the study, applied for funding, and wrote the article. VT, GAW, and IGS analyzed the data. EPH, AA, and IGS contributed to the acquisition and interpretation of the data. EPH, AA, and JJP were involved in drafting the article. EPH, AA, JJP, GAW, and IGS revised the article for important content. JJP, GAW, and IGS contributed to the design of the study. IGS supervised the conduct of the study. VT takes responsibility for the paper as a whole.

 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. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded by a grant from the Department of Emergency Medicine, University of Ottawa. The authors declare no potential conflicts of interest.

 Publication date: Available online November 27, 2009.

 Reprints not available from the authors.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Please see page 465 for the Editor's Capsule Summary of this article.

PII: S0196-0644(09)01619-9

doi: 10.1016/j.annemergmed.2009.10.001

Annals of Emergency Medicine
Volume 55, Issue 5 , Pages 464-472 , May 2010

Article Tools

* Image Usage & Resolution