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Cited by 309Cardiovascular Syncope and Autonomic DisordersEmergency and Acute Care StudiesClinical Reasoning and Diagnostic Skills

Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes

Quinn, James, McDermott, Daniel, Stiell, Ian, Kohn, Michael, Wells, George·2006·Annals of Emergency Medicine
DOI 10.1016/j.annemergmed.2005.11.019
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Abstract

Study objective We prospectively validate the San Francisco Syncope Rule (history of congestive heart failure, Hematocrit <30%, abnormal ECG result [new changes or non-sinus rhythm], complaint of shortness of breath, and systolic blood pressure <90 mm Hg during triage).Methods In a prospective cohort study, consecutive patients with syncope or near syncope presenting to an emergency department (ED) of a teaching hospital were identified and enrolled from July 15, 2002, to August 31, 2004. Patients with trauma, alcohol, or drug-associated loss of consciousness and definite seizures were excluded. Physicians prospectively applied the San Francisco Syncope Rule after their evaluation, and patients were followed up to determine whether they had had a predefined serious outcome within 30 days of their ED visit.Results Seven hundred ninety-one consecutive visits were evaluated for syncope, representing 1.2% of all ED visits. The average age was 61 years, 54% of patients were women, and 59% of patients were admitted. Fifty-three visits (6.7%) resulted in patients having serious outcomes that were undeclared during their ED visit. The rule was 98% sensitive (95% confidence interval [CI] 89% to 100%) and 56% specific (95% CI 52% to 60%) to predict these events. In this cohort, the San Francisco Syncope Rule classified 52% of the patients as high risk, potentially decreasing overall admissions by 7%. If the rule had been applied only to the 453 patients admitted, it might have decreased admissions by 24%.Conclusion The San Francisco Syncope Rule performed with high sensitivity and specificity in this validation cohort and is a valuable tool to help risk stratify patients. It may help with physician decisionmaking and improve the use of hospital admission for syncope.

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Crossref · 10.1016/j.annemergmed.2005.11.019

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  • Arrhythmic syncope is highly probable when the ECG shows persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; Mobitz II second- and third-degree AV block; alternating left and right BBB; VT or rapid paroxysmal SVT.

    “Arrhythmic syncope is highly probable when the ECG shows 25-39 : • Persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; • Mobitz II second- and third-degree AV block; • Alternating left and right BBB; • VT or rapid paroxysmal SVT;”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [26]

  • Structural heart disease and primary electrical disease are major risk factors for sudden cardiac death and overall mortality in patients with syncope.

    “Structural heart disease 25-27,31,35,36,45 and primary electrical disease 46 are major risk factors for sudden cardiac death (SCD) and overall mortality in patients with syncope.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [26]

  • Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction.

    “Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction. 25-39”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [26]

  • A substantial proportion of serious adverse events among patients with syncope are not apparent during initial evaluation in the emergency department.

    “A substantial proportion of serious adverse events are not apparent during initial evaluation in the emergency”

    From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [6]

  • Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department.

    “Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department.”

    From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [6]

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Authors
Quinn, J., McDermott, D., Stiell, I., Kohn, M., & Wells, G.
Affiliations
  • Stanford University (US)
  • University of California, San Francisco (US)
  • University of Ottawa (CA)
Corresponding author
Quinn, James
ORCID
Venue
Annals of Emergency Medicine
Publisher
Elsevier BV
Published
2006-05
Volume
47
Issue
5
Pages
448-454
ISSN
0196-0644 (ISSN-L)
DOI
10.1016/j.annemergmed.2005.11.019
OpenAlex
W2119384358
Cited by
309
References
44
Citations by year
2026: 5 · 2025: 5 · 2024: 20 · 2023: 8 · 2022: 6 · 2021: 9 · 2020: 19 · 2019: 5 · 2018: 23 · 2017: 20 · 2016: 8 · 2015: 15 · 2014: 20 · 2013: 23 · 2012: 23
FWCI
21.08
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Annals of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (7k23ar002137-05)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23 AR002137-050)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords
San Francisco Syncope Rule, syncope, presyncope, risk stratification, emergency department triage, congestive heart failure, hematocrit, electrocardiographic abnormalities, dyspnea, hypotension, hospitalization, diagnostic accuracy
MeSH terms
Arrhythmias, Cardiac, Attitude of Health Personnel, Clinical Protocols, Emergency Medicine, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Syncope, Cohort Studies, Risk Assessment

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