title: Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes.
abstract: 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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Emergency Medicine, Stanford University, Palo Alto, CA 94304, USA. quinnj@stanford.edu
authors.forename: James
authors.initials: J
authors.lastname: Quinn
authors.forename: Daniel
authors.initials: D
authors.lastname: McDermott
authors.forename: Ian
authors.initials: I
authors.lastname: Stiell
authors.forename: Michael
authors.initials: M
authors.lastname: Kohn
authors.forename: George
authors.initials: G
authors.lastname: Wells
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis; D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D015331:Cohort Studies; D004635:Emergency Medicine / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology