title: The ROSE (risk stratification of syncope in the emergency department) study.
abstract: OBJECTIVE
  The aim of this study was to develop and validate a clinical decision rule (CDR) to predict 1-month serious outcome and all-cause death in patients presenting with syncope to the emergency department.
  
  
  BACKGROUND
  Syncope is a common, potentially serious condition accounting for many hospital admissions.
  
  
  METHODS
  This was a single center, prospective, observational study of adults presenting to the emergency department with syncope. A CDR was devised from 550 patients in a derivation cohort and tested in a validation cohort of a further 550 patients.
  
  
  RESULTS
  One-month serious outcome or all-cause death occurred in 40 (7.3%) patients in the derivation cohort. Independent predictors were brain natriuretic peptide concentration > or =300 pg/ml (odds ratio [OR]: 7.3), positive fecal occult blood (OR: 13.2), hemoglobin < or =90 g/l (OR: 6.7), oxygen saturation < or =94% (OR: 3.0), and Q-wave on the presenting electrocardiogram (OR: 2.8). One-month serious outcome or all-cause death occurred in 39 (7.1%) patients in the validation cohort. The ROSE (Risk stratification Of Syncope in the Emergency department) rule had a sensitivity and specificity of 87.2% and 65.5%, respectively, and a negative predictive value of 98.5%. An elevated B-type natriuretic peptide (BNP) concentration alone was a major predictor of serious cardiovascular outcomes (8 of 22 events, 36%) and all-cause deaths (8 of 9 deaths, 89%).
  
  
  CONCLUSIONS
  The ROSE rule has excellent sensitivity and negative predictive value in the identification of high-risk patients with syncope. As a component, BNP seems to be a major predictor of serious cardiovascular outcomes and all-cause death. The ROSE rule and BNP measurement might be valuable risk stratification tools in patients with emergency presentations of syncope and should now be subjected to external validation.
authors.affiliation: Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. matthew.reed@luht.scot.nhs.uk
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reed
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Coull
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Prescott
authors.forename: Keith G
authors.initials: KG
authors.lastname: Jacques
authors.forename: Alasdair J
authors.initials: AJ
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013575:Syncope / Q000401:mortality*