The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index.
Prospective Validation of the San Francisco Syncope Rule to Predict Patients With Serious Outcomes
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
Incidence and Prognosis of Syncope
Soteriades, E. S., Evans, J. C., Larson, M. G., Chen, M. H., Chen, L., Benjamin, E. J., & Levy, D. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa012407 · Cited by 1,364
Clinical Prediction Rules: Applications and Methodological Standards
Wasson, J. H., Sox, H. C., Neff, R. K., & Goldman, L. (1985) · New England Journal of Medicine · doi:10.1056/nejm198509263131306 · Cited by 1,357
The Canadian C-Spine Rule for Radiography in Alert and Stable Trauma Patients
Stiell, I. G. (2001) · JAMA · doi:10.1001/jama.286.15.1841 · Cited by 1,293
Self-citationLaupacis, A. (1997) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1997.03540300056034 · Cited by 793
A Prospective Evaluation and Follow-up of Patients with Syncope
Kapoor, W. N., Karpf, M., Wieand, S., Peterson, J. R., & Levey, G. S. (1983) · New England Journal of Medicine · doi:10.1056/nejm198307283090401 · Cited by 779
Methodologic Standards for the Development of Clinical Decision Rules in Emergency Medicine
STIELL, I., & WELLS, G. (1999) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(99)70309-4 · Cited by 571
Self-citationGuidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary.
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janoušek, J., et al. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.09.004 · Cited by 566
Linzer, M., Yang, E. H., Estes III, N. A. M., Wang, P., Vorperian, V. R., & Kapoor, W. N. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-126-12-199706150-00012 · Cited by 437
Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes
Quinn, J. V., Stiell, I. G., McDermott, D. A., Sellers, K. L., Kohn, M. A., & Wells, G. A. (2004) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(03)00823-0 · Cited by 432
Self-citationColivicchi, F. (2003) · European Heart Journal · doi:10.1016/s0195-668x(02)00827-8 · Cited by 359
Research works printed but not linked: 4
- Gallagher, 1997, Hospitalization for fainting, Ann Emerg Med., 29, 540
- Schillinger, 2000, Admission for syncope, Wien Klin Wochenschr, 112, 835
- Bartoletti, 2004, After the 2001 European Society of Cardiology guidelines, Minerva Med., 95, 451
- Del Greco, 2003, Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital, Ital Heart J., 4, 99
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Items 301–309 of 309
Fits, faints, funny turns, and falls in the differential diagnosis of the dizzy patient
Tarnutzer, A. A., & Newman‐Toker, D. E. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780198834380.003.0027
Remote Cardiovascular Consultations: Bridging Distances in Primary Care
Solari, M., Vaona, A., Menichetti, F., Mevsim, V., Heguia, H., Özkaya, Y., & Ecarnot, F. (2025) · TELe-Health · doi:10.1007/978-3-031-89661-3_14
Syncope Diagnosis and Management with the Help of Artificial Intelligence
Levra, A. G. (2025) · Springer eBooks · doi:10.1007/978-3-031-95256-2_11
Doğan, B., Komut, S., Sultanoğlu, H., Duran, C., Yazla, M., & Günsay, R. H. (2025) · The European Research Journal · doi:10.18621/eurj.1802723
Brignole, M., & Benditt, D. G. (2010) · Springer eBooks · doi:10.1007/978-0-85729-201-8_16
Knudsen, A., Struijk, J. J., Riahi, S., Andersen, M. P., Christensen, H. C., Torp-Pedersen, C. T., Kragholm, K. H., Polcwiartek, C., Kanters, J. K., & Graff, C. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.043466
Knudsen, A., Struijk, J. J., Riahi, S., Andersen, M. P., Christensen, H. C., Torp-Pedersen, C. T., Kragholm, K. H., Kanters, J. K., Polcwiartek, C., & Graff, C. (2026) · Scientific Reports · doi:10.1038/s41598-026-49475-2
Situ-LaCasse, E., Wallace, N., Wasiak, D., Patel, P., & Adhikari, S. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15103780
Barón‐Esquivias, G., Fernández‐Cisnal, A., Arce‐León, Á., Toro, R., Cantero-Pérez, E. M., Parejo-Matos, J., Romero-Rodríguez, N., Montero, E., & Martı́nez, Á. (2015) · Clinical Trials and Regulatory Science in Cardiology · doi:10.1016/j.ctrsc.2015.05.001
Metadata
- 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
- Venue
- Annals of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2006-05
- Volume
- 47
- Issue
- 5
- Pages
- 448-454
- ISSN
- 0196-0644 (ISSN-L)
- 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
- 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 › Cardiology and Cardiovascular Medicine › 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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