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Cited by 69Cardiovascular Syncope and Autonomic DisordersClinical Reasoning and Diagnostic SkillsEmergency and Acute Care Studies

San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio risk score, and clinical judgment in the assessment of short-term outcome of syncope

Dipaola, Franca, Costantino, Giorgio, Perego, Francesca, Borella, Marta, Galli, Andrea, Cantoni, Giulia, Barbic, Franca, Casella, Francesco +2 more·2010·The American Journal of Emergency Medicine
DOI 10.1016/j.ajem.2008.12.039
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Abstract

Objective The study aimed to compare the efficacy of the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score, San Francisco Syncope Rule, and clinical judgment in assessing the short-term prognosis of syncope.Methods We studied 488 patients consecutively seen for syncope at the emergency department of 2 general hospitals between January and July 2004. Sensitivity, specificity, predictive values, and likelihood ratios for short-term (within 10 days) severe outcomes were computed for each decision rule and clinical judgment. Severe outcomes comprised death, major therapeutic procedures, and early readmission to hospital.Results Clinical judgment had a sensitivity of 77%, a specificity of 69%, and would have admitted less patients (34%, P < .05 vs decision rules). The OESIL risk score was characterized by a sensitivity of 88% and a specificity of 60% (admission 43%). San Francisco Syncope Rule sensitivity was 81% and specificity was 63% (admission 40%). According to both clinical rules, no discharged patient would have died. With combined OESIL risk score and clinical judgment, the probability of adverse events was 0.7% for patients with both low risk scores, whereas that for both high risk scores was roughly 16%.Conclusion Because of a relatively low sensitivity, both risk scores were partially lacking in recognizing patients with short-term high-risk syncope. However, the application of the decision rules would have identified all patients who subsequently died, and OESIL risk score and clinical judgment combined seem to improve the decision-making process concerning the identification of high-risk patients who deserve admission.

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  • None of the emergency department syncope clinical decision rules are used widely in emergency departments due to poor sensitivity and specificity reported from external validation, or due to a lack of external validation.

    “None of these rules are used widely in EDs due to poor sensitivity and specificity reported from external validation, or due to a lack of external validation. 70,78-85”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [79]

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Authors
Dipaola, F., Costantino, G., Perego, F., Borella, M., Galli, A., Cantoni, G., Barbic, F., Casella, F., Duca, P. G., & Furlan, R.
Affiliations
  • University of Milan (IT)
  • Azienda Ospedaliera Fatebenefratelli e Oftalmico (IT)
Corresponding author
Furlan, Raffaello
ORCID
Venue
The American Journal of Emergency Medicine
Publisher
Elsevier BV
Published
2010-05
Volume
28
Issue
4
Pages
432-439
ISSN
0735-6757 (ISSN-L)
DOI
10.1016/j.ajem.2008.12.039
OpenAlex
W2064936770
Cited by
69
References
24
Citations by year
2026: 2 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 5 · 2018: 8 · 2017: 7 · 2016: 3 · 2015: 4 · 2014: 8 · 2013: 6 · 2012: 6
FWCI
6.07
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
syncope, San Francisco Syncope Rule, risk score, clinical judgment, short-term prognosis, hospitalization, emergency department decision-making, sensitivity and specificity, likelihood ratios, mortality prediction
MeSH terms
Electrocardiography, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Sensitivity and Specificity, Severity of Illness Index, Syncope, Chi-Square Distribution, Logistic Models, Outcome Assessment, Health Care, Practice Guidelines as Topic

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