The Risk stratification Of Syncope in the Emergency department (ROSE) pilot study: a comparison of existing syncope guidelines
Open accessAbstract
AIMS: This study was conducted as a feasibility pilot for the Risk stratification Of Syncope in the Emergency department (ROSE) study. The secondary aim was to compare the performance of our existing emergency department (ED) guidelines with existing clinical decision rules (Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) Score and San Francisco Syncope Rule; SFSR) at predicting short-term (1 week and 1 month) and medium-term (3 months) serious outcomes for patients with syncope presenting to the ED. METHODS: This was a prospective cohort study. All patients presenting with syncope aged > or = 16 years between 7 November 2005 and 7 February 2006 were prospectively enrolled. RESULTS: 99 patients were recruited over a 3-month period. 44 patients were admitted and 55 discharged from the ED. 11 patients had a serious outcome: 8 by 7 days and a further 3 by 3 months. Five patients died by 3 months and six others had an alternative serious outcome. All 11 patients had been admitted from the ED, 7 were at high risk, 4 were at medium risk and none were at low risk according to our existing ED guidelines. Percentages of serious outcomes were 0%, 2.9%, 8.0%, 22.7% and 37.5% for OESIL scores of 0, 1, 2, 3 and 4 respectively. 40 patients had none of the 5 SFSR high-risk factors (0 serious outcomes = 0%) and 59 patients had an SFSR high-risk factor (11 serious outcomes = 18.6%). The risk of serious outcome at 7 days, 1 month and 3 months was 8.1%, 8.1% and 11.1%, respectively. CONCLUSIONS: A study to derive and validate a UK ED syncope clinical decision rule is feasible. This pilot study has evaluated the OESIL score, the SFSR and our existing ED guidelines, and has shown that each is able to identify an increased probability of medium-term serious outcome in patients with syncope. The SFSR shows good sensitivity at the expense of an increase in admissions to hospital; however, our existing ED syncope guidelines and the OESIL Score, although being able to successfully risk stratify patients, are not sufficiently sensitive to be able to reduce admissions without missing patients at risk of a serious outcome. Undoubtedly there is a need for a simple UK-derived clinical decision rule for patients presenting with syncope to enable safe, effective clinical care and to aid less experienced decision makers.
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The San Francisco Syncope Rule performed poorly on external validation at various study sites, which made it unacceptable for adoption into practice.
“It performed poorly on external validation at various study sites, which made it unacceptable for adoption into practice. 7,12,27”
From Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope (2016) · cites this paper as [27]
The San Francisco Syncope Rule section reports that using the rule at this UK emergency department would have caused 15 additional admissions without improving sensitivity. The discussion likewise questions its practical value, but this was a single-site pilot, not evidence of poor external-validation performance at various sites; the paper does not call the rule unacceptable for adoption. Page numbers were not supplied in our copy. (LLM, conf=0.84)
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Cites
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The ROSE (Risk Stratification of Syncope in the Emergency Department) Study
Reed, M. J., Newby, D. E., Coull, A. J., Prescott, R. J., Jacques, K. G., & Gray, A. J. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.09.049 · Cited by 272 · see citing works
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Serrano, L. A., Hess, E. P., Bellolio, M. F., Murad, M. H., Montori, V. M., Erwin, P. J., & Decker, W. W. (2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.05.013 · Cited by 129 · see citing works
Sheldon, R. S., Morillo, C. A., Krahn, A. D., O'Neill, B., Thiruganasambandamoorthy, V., Parkash, R., Talajic, M., Tu, J. V., Seifer, C., Johnstone, D., et al. (2011) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2010.11.002 · Cited by 126 · see citing works
External validation of the San Francisco Syncope Rule in the Canadian setting
Thiruganasambandamoorthy, V., Hess, E. P., Alreesi, A., Perry, J. J., Wells, G. A., & Stiell, I. G. (2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2009.10.001 · Cited by 88 · see citing works
Priorities for Emergency Department Syncope Research
Sun, B. C., Costantino, G., Barbic, F., Bossi, I., Casazza, G., Dipaola, F., McDermott, D., Quinn, J., Reed, M., Sheldon, R. S., et al. (2014) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2014.04.014 · Cited by 86 · see citing works
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SHELDON, R., HERSI, A., RITCHIE, D., KOSHMAN, M., & ROSE, S. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01835.x · Cited by 61 · see citing works
Outcomes in Canadian Emergency Department Syncope Patients – Are We Doing a Good Job?
Thiruganasambandamoorthy, V., Hess, E. P., Turko, E., Perry, J. J., Wells, G. A., & Stiell, I. G. (2013) · The Journal of Emergency Medicine · doi:10.1016/j.jemermed.2012.06.028 · Cited by 53 · see citing works
Application of San Francisco Syncope Rule in elderly ED patients
Schladenhaufen, R., Feilinger, S., Pollack, M., Benenson, R., & Kusmiesz, A. L. (2008) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2007.10.042 · Cited by 45 · see citing works
Sule, S., Palaniswamy, C., Aronow, W. S., Ahn, C., Peterson, S. J., Adapa, S., & Mudambi, L. (2011) · Clinical Cardiology · doi:10.1002/clc.20872 · Cited by 35 · see citing works
- Authors
- Reed, M. J., Newby, D. E., Coull, A. J., Jacques, K. G., Prescott, R. J., & Gray, A. J.
- Affiliations
- Edinburgh Royal Infirmary (GB)
- University of Edinburgh (GB)
- Corresponding author
- Reed, M. J
- Venue
- Emergency Medicine Journal
- Publisher
- BMJ
- Published
- 2007-04-01
- Volume
- 24
- Issue
- 4
- Pages
- 270-275
- ISSN
- 1351-0622 (ISSN-L)
- 1472-0205
- 1472-0213
- PMC
- PMC2658233
- OpenAlex
- W2151025268
- Cited by
- 78
- References
- 3
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 2 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 7 · 2015: 4 · 2014: 9 · 2013: 5 · 2012: 9
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Emergency Medicine Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
- 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
- syncope, risk stratification, clinical decision rules, San Francisco Syncope Rule, hospitalization, risk prediction, pilot study feasibility
- MeSH terms
- Adolescent, Adult, Emergency Medicine, Emergency Service, Hospital, Feasibility Studies, Female, Humans, Male, Pilot Projects, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Syncope, Likelihood Functions, Practice Guidelines as Topic, Risk Assessment
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