Prospective Validation of the San Francisco Syncope Rule to Predict Patients With Serious Outcomes

Quinn, James V.; McDermott, Daniel; Stiell, Ian G.; Kohn, Michael A.; Wells, George A.

doi:10.1016/j.annemergmed.2005.11.019

Cited by 251 publications

(185 citation statements)

References 35 publications

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“…The SFSR has been validated by the same investigators in a separate cohort of 791 patients, obtaining a sensitivity of 98% (95% CI 89%-100%) and a specificity of 56% (95% CI 52%-60%) for adverse events at 30-day follow-up. 16 The use of this rule would have resulted in a 7% potential reduction of hospital admissions (Tables 2 and 3).…”

Section: Sfsrmentioning

confidence: 99%

Syncope Risk Stratification in the Emergency Department

Costantino

Furlan

2013

Cardiology Clinics

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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.

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Section: Sfsrmentioning

confidence: 99%

Syncope Risk Stratification in the Emergency Department

Costantino

Furlan

2013

Cardiology Clinics

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“…Chi-square was used for analysis of the remainder of the predictor variables. 3 Variables not found to be significantly associated with SAEs. 4 Nausea, vomiting, dizziness, visual disturbances, or sweating.…”

Section: Discussionmentioning

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%

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

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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

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“…An early readmission was defined as any patient discharged from ED after syncope and then readmitted to hospital for the same or similar symptoms in keeping with previous studies (6,19). These patients were considered to be at high risk for developing a severe outcome.…”

Section: Respective Methodologymentioning

confidence: 99%

“…As shown in Figure 1, 80 patients were enrolled and evaluated according to syncope guidelines (18,19). Physicians were free to discharge or admit patients according to their clinical decision.…”

Section: Respective Methodologymentioning

confidence: 99%

Utility of Serum S100B Level, SFSR and OESIL Scores in Anticipating Short Term Adverse Events of Discharged Syncope Patients

Akoğlu¹,

Denizbaşı²,

Güneysel³

et al. 2012

JAEM

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Objective: Our aim is to evaluate S100β in serum in addition to clinical syncope decision rules and to determine the utility of this parameter along with OESIL and SFSR for any short term (10 days) adverse events. Material and Methods: This observational prospective cohort study included all consecutive patients older than 18 years who presented to the ED of Marmara University Hospital between June 2005 and January 2007 with the complaint of syncope within the previous 48 hours unless they had exclusion criteria. Two hundred and fifty-four patients were admitted, 80 were enrolled and 62 completed the follow-up. Multivariable logistic regression analysis was used to develop a risk score to predict the probability any adverse event in the short term using parameters of OESIL risk score, SFSR and serum S-100β level. Results: Patients with any short term adverse events had a higher pulse rate, lower hematocrit and hemoglobin levels, and higher serum S100B levels on admission. There were no significant differences between the accuracies of OESIL, SFS Rule and S100B level. Absence of prodromal symptoms, abnormal ECG and high serum S100B level were significant contributors of the model of adverse events. OESIL and S100B level were relatively effective compared to SFSR. The predictive value of each risk score was increased when combined with S100B level. Conclusion: The OESIL and SFSR were ineffective in recognizing patients with adverse events because of relatively low sensitivity. Serum S100B level seems to be a promising biochemical test which may increase the utility of prognostic syncope risk scales. (JAEM 2013; 12: 1-7) Key words: S100B protein, syncope, sensitivity and specificity ÖzetAmaç: Serum S100β değerini OESIL ve San Fransisko Senkop Kuralı (SFSK) gibi senkop klinik karar verme kurallarıyla birleştirerek erken dönem (10 gün) advers olay riskini belirlemede sağladığı faydayı belirlemeyi hedefledik. Gereç ve Yöntemler: Bu gözlemsel prospektif kohort çalışmasına, 2005 Haziran ve 2007 Ocak ayları arasında Marmara Üniversitesi Acil Servisine son 48 saat içerisinde bayılma şikayetiyle başvuran, 18 yaşından büyük ve dışlanma kriterlerini içermeyen tüm hastalar dahil edilmiştir. Taranan 254 hastadan 80'i çalışmaya dahil edilmiş, 62'si çalışmayı tamamlamıştır. OESIL ve SFSK'nın parametreleri ve serum S100β değeri çoklu regresyon analizi ile incelenerek erken dönemde herhangi bir advers olay olasılığını öngördürecek bir risk skoru geliştirilmeye çalışılmıştır. Bulgular: Erken dönemde advers olay görülen hastaların başvuru esnasında daha yüksek nabız hızı, daha düşük hematokrit ve hemoglobin düzeyleri ve daha yüksek serum S100β düzeyine sahip oldukları belirlenmiştir. OESIL skoru, SFSK ve S100β düzeylerinin kesinlikleri (accuracy) arasında istaitstiksel olarak anlamlı fark tespit edilmemiştir. Prodromal semptom olmaması, anormal EKG varlığı ve yüksek serum S100β düzeyi advers olayı belirleyebilecek regresyon modeline anlamlı katkıda bulunan değişkenler olarak belirlenmişlerdir. OESIL risk skoru ve S100B düz...

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Prospective Validation of the San Francisco Syncope Rule to Predict Patients With Serious Outcomes

Cited by 251 publications

References 35 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

Utility of Serum S100B Level, SFSR and OESIL Scores in Anticipating Short Term Adverse Events of Discharged Syncope Patients

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