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

Thiruganasambandamoorthy, Venkatesh; Hess, Erik P.; Al-Reesi, Abdullah; Perry, Jeffrey J.; Wells, George A.; Stiell, Ian G.

doi:10.1016/j.annemergmed.2009.10.001

Cited by 79 publications

(70 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10,[17][18][19] These inconsistencies might be related to the heterogeneous ECG interpretation characterizing those studies. 10 old] ST-T wave changes); 4, complaint of shortness of breath.…”

Section: Sfsrmentioning

confidence: 98%

Syncope Risk Stratification in the Emergency Department

Costantino

Furlan

2013

Cardiology Clinics

View full text Add to dashboard Cite

An 89-year-old What steps should be taken to deal with a patient presenting at the ED because of a transient loss of consciousness? THE FIRST STEP: IDENTIFYING PATIENTS WITH SYNCOPETo identify the patient with syncope, 3 major issues have to be addressed:Distinguish patients with syncope from those with a transient loss of consciousness (T-LoC) of nonsyncopal origin Differentiate patients with syncope from those having falls Determine how to manage patients presenting with near syncopeThe authors have nothing to disclose.

show abstract

Section: Sfsrmentioning

confidence: 98%

Syncope Risk Stratification in the Emergency Department

Costantino

Furlan

2013

Cardiology Clinics

View full text Add to dashboard Cite

show abstract

“…21 The interobserver agreements for inclusion into the study and for the two predictor variables (history of shortness of breath and history of congestive heart failure) have also been previously reported. 4 We conducted multivariate analysis using logistic regression with stepwise selection incorporating the 12 predictor variables that were significant on univariate analysis (p , 0.05) and the Ottawa Electrocardiographic Criteria variable. Based on the above-mentioned characteristics of patients with missing predictor variables, we assumed that the condition was absent for categorical variables and the values were normal for continuous variables.…”

Section: Resultsmentioning

confidence: 99%

“…2,8,10,14,15 All the instruments arising from these efforts have either not been validated or have performed poorly on external validation. [4][5][6]15 Most such instruments, if applied in the Canadian setting, will likely substantially increase admission rates. 4 In addition, many previous decision instruments have been limited by an imprecise definition of the ''abnormal electrocardiogram (ECG)'' variable, resulting in a reduction in specificity.…”

Section: 35-11mentioning

confidence: 99%

“…[4][5][6]15 Most such instruments, if applied in the Canadian setting, will likely substantially increase admission rates. 4 In addition, many previous decision instruments have been limited by an imprecise definition of the ''abnormal electrocardiogram (ECG)'' variable, resulting in a reduction in specificity. As a result, risk stratification and the disposition of syncope patients remain challenges for emergency physicians.…”

Section: 35-11mentioning

confidence: 99%

“…Among ED syncope patients, 7 to 23% will suffer a serious adverse event (SAE) within 7 to 30 days of their visit. [2][3][4][5][6][7][8][9][10] These include death, arrhythmia, myocardial infarction, diagnosis of serious underlying structural heart disease, or procedural interventions to treat the cause of the syncopal event.…”

Section: Ré Sumémentioning

confidence: 99%

See 2 more Smart Citations

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Thiruganasambandamoorthy

Wells

Hess

et al. 2014

CJEM

Self Cite

View full text Add to dashboard Cite

Background: Determining the appropriate disposition of emergency department (ED) syncope patients is challenging. Previously developed decision tools have poor diagnostic test characteristics and methodological flaws in their derivation that preclude their use. We sought to develop a scale to risk-stratify adult ED syncope patients at risk for serious adverse events (SAEs) within 30 days. Methods: We conducted a medical record review to include syncope patients age $ 16 years and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected 105 predictor variables (demographics, event characteristics, comorbidities, medications, vital signs, clinical examination findings, emergency medical services and ED electrocardiogram/monitor characteristics, investigations, and disposition variables) and information on the occurrence of predefined SAEs. Univariate and multiple logistic regression analyses were performed. Results: Among 505 enrolled patient visits, 49 (9.7%) suffered an SAE. Predictors of SAE and their resulting point scores were as follows: age $ 75 years (1), shortness of breath (2), lowest ED systolic blood pressure , 80 mm Hg (2), Ottawa Electrocardiographic Criteria present (2), and blood urea nitrogen . 15 mmol/L (3). The final score calculated by addition of the individual scores for each variable (range 0-10) was found to accurately stratify patients into low risk (score , 1, 0% SAE risk), moderate risk (score 1, 3.7% SAE risk), or high risk (score . 1, $ 10% SAE risk). Conclusion: We derived a risk scale that accurately predicts SAEs within 30 days in ED syncope patients. If validated, this

show abstract

Multicenter Emergency Department Validation of the Canadian Syncope Risk Score

Thiruganasambandamoorthy

Sivilotti

Sage

et al. 2020

JAMA Intern Med

View full text Add to dashboard Cite

IMPORTANCEThe management of patients with syncope in the emergency department (ED) is challenging because no robust risk tool available has been recommended for clinical use.OBJECTIVE To validate the Canadian Syncope Risk Score (CSRS) in a new cohort of patients with syncope to determine its ability to predict 30-day serious outcomes not evident during index ED evaluation. DESIGN, SETTING, AND PARTICIPANTSThis prospective multicenter cohort study conducted at 9 EDs across Canada included patients 16 years and older who presented to EDs within 24 hours of syncope. Patients were enrolled from March 2014 to April 2018. MAIN OUTCOMES AND MEASURES Baseline characteristics, CSRS predictors, and 30-day adjudicated serious outcomes, including arrhythmic (arrhythmias, interventions for arrhythmia, or unknown cause of death) and nonarrhythmic (myocardial infarction, structural heart disease, pulmonary embolism, or hemorrhage) serious outcomes, were collected. Calibration and discrimination characteristics for CSRS validation were calculated. RESULTS A total of 3819 patients were included (mean [SD] age 53.9 [22.8] years; 2088 [54.7%] female), of whom 139 (3.6%) experienced 30-day serious outcomes, including 13 patients (0.3%) who died. In the validation cohort, there were no differences between the predicted and observed risk, the calibration slope was 1.0, and the area under the receiver operating characteristic curve was 0.91 (95% CI, 0.88-0.93). The empirical probability of a 30-day serious outcome during validation was 3.64% (95% CI, 3.09%-4.28%) compared with the model-predicted probability of 3.17% (95% CI, 2.66%-3.77%; P = .26). The proportion of patients with 30-day serious outcomes increased from 3 of 1631 (0.3%) in the very-low-risk group to 40 of 78 (51.3%) in the very-high-risk group (Cochran-Armitage trend test P < .001). There was a similar significant increase in the serious outcome subtypes with increasing CSRS risk category. None of the very-low-risk and low-risk patients died or experienced ventricular arrhythmia. At a threshold score of −1 (2145 of 3819 patients), the CSRS sensitivity and specificity were 97.8% (95% CI, 93.8%-99.6%) and 44.3% (95% CI, 42.7%-45.9%), respectively. CONCLUSIONS AND RELEVANCEThe CSRS was successfully validated and its use is recommended to guide ED management of patients when serious causes are not identified during index ED evaluation. Very-low-risk and low-risk patients can generally be discharged, while brief hospitalization can be considered for high-risk patients. We believe CSRS implementation has the potential to improve patient safety and health care efficiency.

show abstract

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

Cited by 79 publications

References 23 publications

Syncope Risk Stratification in the Emergency Department

Syncope Risk Stratification in the Emergency Department

Derivation of a risk scale and quantification of risk factors for serious adverse events in adult emergency department syncope patients

Multicenter Emergency Department Validation of the Canadian Syncope Risk Score

Contact Info

Product

Resources

About