EBQ:San Francisco Syncope Rule: Difference between revisions
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==Conclusion== | ==Conclusion== | ||
*The San Francisco Syncope Rule demonstrated to be highly sensitive (98% sensitivity, 95% CI 89-100%) but not very specific (56%, 95% CI 52-60%) for predicting serious outcomes. | |||
==Major Points== | ==Major Points== |
Revision as of 17:54, 24 August 2014
Under Review Journal Club Article
Quinn J. et al.. "Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes". Ann Emerg Med. 2006. 31(26):2992-6.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
Can the San Francisco Syncope Rule be used in clinical practice to risk stratify patients presenting with syncope?
Conclusion
- The San Francisco Syncope Rule demonstrated to be highly sensitive (98% sensitivity, 95% CI 89-100%) but not very specific (56%, 95% CI 52-60%) for predicting serious outcomes.
Major Points
- Criteria (CHESS Pneumonic)[1]
- CHF History
- Hct < 30%
- ECG Abnormality
- SOB history
- SBP < 90mmHg at triage
Study Design
- A prospective cohort study
- Consecutive patients with syncope or near syncope presenting to an emergency department of a large, urban teaching hospital were identified and enrolled from July 15, 2002 to August 31, 2004
- Physicians prospectively applied the San Francisco Syncope Rule
- Patient follow up performed to determine if the patient suffered a predefined serious outcome within 30 days of their ED visit
- Physicians completed a short Web-based form and enrolled patients after their assessment
- Study investigators reviewed all data forms in order to ensure the correct interpretation of the rule,
Population
Patient Demographics
- 364 men, 427 females
- Mean age: 61
- Admitted: 469
- Patients with serious outcomes after ED visit: 54 (6.8%)
- Death: 3
- Arrhythmia: 23
- Myocardial Infarction: 11
- Valvular Heart Disease: 1
- Significant Hemorrhage: 7
- TIA/Stroke: 3
- Sepsis: 3
- Admission after ED Discharge : 3
Inclusion Criteria
- Consecutive patients presenting with syncope or near syncope without any of the predefined exclusion criteria
Exclusion Criteria
- Trauma-related loss of consciousness
- Alcohol-related loss of consciousness
- Drug-related loss of consciousness
- Definite seizure
Interventions
Outcomes
Primary Outcome
Secondary Outcomes
Subgroup analysis
Criticisms & Further Discussion
Funding
- A career development grant from the National Institutes of Health available to Dr. James Quinn, MD, MS, primary investigator of the study
Sources
- ↑ Quinn J, McDermott D, Stiell I, Kohn M, Wells G. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006 May;47(5):448-54. PubMed PMID: 16631985.