| External validation of the San Francisco Syncope Rule in the Canadian setting. | |
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MedLine Citation:
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PMID: 19944489 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: Syncope is a common disposition challenge for emergency physicians. Among the risk-stratification instruments available, only the San Francisco Syncope Rule is rigorously developed. We evaluate its performance in Canadian emergency department (ED) syncope patients. METHODS: This retrospective review included patients aged 16 years or older who fulfilled the definition of syncope (transient loss of consciousness with complete recovery) and presented to a tertiary care ED during an 18-month period. We excluded patients with ongoing altered mental status, alcohol/illicit drug use, seizure, and head and severe trauma. Patient characteristics, 5 predictors for the rule (history of congestive heart failure, hematocrit level <30%, abnormal ECG characteristics, shortness of breath, and triage systolic blood pressure <90 mm Hg), and outcomes (as per the original study) were extracted. RESULTS: Of 915 visits screened, 505 were included. Forty-nine (9.7%) visits were associated with serious outcomes. The rule performed with a sensitivity of 90% (44/49 outcomes; 95% confidence interval [CI] 79% to 96%) and a specificity of 33% (95% CI 32% to 34%). Including monitor abnormalities in the ECG variable would improve sensitivity to 96% (47/49 outcomes; 95% CI 87% to 99%). Although physicians failed to predict 2 deaths, the rule would have predicted all 3 deaths that occurred after ED discharge. Implementing the rule in our setting would increase the admission rate from 12.3% to 69.5%. CONCLUSION: In this retrospective Canadian study, the San Francisco Syncope Rule performed with comparable sensitivity but significantly poorer specificity than previously reported. Implementing the rule would significantly increase admission rates. Further studies to either refine the San Francisco Syncope Rule or develop a new rule are needed. |
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Authors:
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Venkatesh Thiruganasambandamoorthy; Erik P Hess; Abdullah Alreesi; Jeffrey J Perry; George A Wells; Ian G Stiell |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Validation Studies Date: 2009-11-27 |
Journal Detail:
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Title: Annals of emergency medicine Volume: 55 ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-04-26 Completed Date: 2010-05-07 Revised Date: 2011-01-10 |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 464-72 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2009. Published by Mosby, Inc. |
Affiliation:
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Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. pondyvenki@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Diagnostic Tests, Routine / standards Emergency Medical Services / standards, statistics & numerical data Female Hospitalization Humans Male Middle Aged Monitoring, Physiologic Ontario Patient Discharge / statistics & numerical data Practice Guidelines as Topic / standards* Retrospective Studies Sensitivity and Specificity Syncope / diagnosis*, etiology Treatment Outcome Young Adult |
| Comments/Corrections | |
Comment In:
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Ann Emerg Med. 2011 Jan;57(1):72-3; author reply 73
[PMID:
20828875
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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