External Validation of the San Francisco Syncope Rule

Benjamin Sun, Carol M. Mangione, Guy Merchant, Timothy Weiss, Gil Z. Shlamovitz, Gelareh Zargaraff, Sharon Shiraga, Jerome R. Hoffman, William R. Mower

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Study objective: We externally validate the ability of the San Francisco Syncope Rule to accurately identify syncope patients who will experience a 7-day serious clinical event. Methods: Patients who presented to a single academic emergency department (ED) between 8 am and 10 pm with syncope or near-syncope were prospectively enrolled. Treating physicians recorded the presence or absence of all San Francisco Syncope Rule risk factors. Patients were contacted by telephone at 14 days for a structured interview. A 3-physician panel, blinded to the San Francisco Syncope Rule score, reviewed ED medical records, hospital records, and telephone interview forms to identify predefined serious clinical events. The primary outcome was the ability of the San Francisco Syncope Rule to predict any 7-day serious clinical event. A secondary outcome was the ability of the San Francisco Syncope Rule to predict 7-day serious clinical events that were not identified during the initial ED evaluation. Results: Of 592 eligible patients, 477 (81%) provided informed consent. Direct telephone contact or admission/outpatient records were successfully obtained for 463 (97%) patients. There were 56 (12%) patients who had a serious 7-day clinical event, including 16 (3%) who received a diagnosis after the initial ED evaluation. Sensitivity and specificity of the San Francisco Syncope Rule for the primary outcome were 89% (95% confidence interval [CI] 81% to 97%) and 42% (95% CI 37% to 48%), respectively, and 69% (95% CI 46% to 92%) and 42% (95% CI 37% to 48%), respectively, for the secondary outcome. Estimates of sensitivity were minimally affected by missing data and most optimistic assumptions for missing follow-up information. Conclusion: In this external validation cohort, the San Francisco Syncope Rule had a lower sensitivity and specificity than in previous reports.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume49
Issue number4
DOIs
StatePublished - Apr 2007
Externally publishedYes

Fingerprint

San Francisco
Syncope
Hospital Emergency Service
Confidence Intervals
Telephone
Interviews
Physicians
Sensitivity and Specificity
Hospital Records
Informed Consent
Medical Records
Outpatients

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Sun, B., Mangione, C. M., Merchant, G., Weiss, T., Shlamovitz, G. Z., Zargaraff, G., ... Mower, W. R. (2007). External Validation of the San Francisco Syncope Rule. Annals of Emergency Medicine, 49(4). https://doi.org/10.1016/j.annemergmed.2006.11.012

External Validation of the San Francisco Syncope Rule. / Sun, Benjamin; Mangione, Carol M.; Merchant, Guy; Weiss, Timothy; Shlamovitz, Gil Z.; Zargaraff, Gelareh; Shiraga, Sharon; Hoffman, Jerome R.; Mower, William R.

In: Annals of Emergency Medicine, Vol. 49, No. 4, 04.2007.

Research output: Contribution to journalArticle

Sun, B, Mangione, CM, Merchant, G, Weiss, T, Shlamovitz, GZ, Zargaraff, G, Shiraga, S, Hoffman, JR & Mower, WR 2007, 'External Validation of the San Francisco Syncope Rule', Annals of Emergency Medicine, vol. 49, no. 4. https://doi.org/10.1016/j.annemergmed.2006.11.012
Sun B, Mangione CM, Merchant G, Weiss T, Shlamovitz GZ, Zargaraff G et al. External Validation of the San Francisco Syncope Rule. Annals of Emergency Medicine. 2007 Apr;49(4). https://doi.org/10.1016/j.annemergmed.2006.11.012
Sun, Benjamin ; Mangione, Carol M. ; Merchant, Guy ; Weiss, Timothy ; Shlamovitz, Gil Z. ; Zargaraff, Gelareh ; Shiraga, Sharon ; Hoffman, Jerome R. ; Mower, William R. / External Validation of the San Francisco Syncope Rule. In: Annals of Emergency Medicine. 2007 ; Vol. 49, No. 4.
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abstract = "Study objective: We externally validate the ability of the San Francisco Syncope Rule to accurately identify syncope patients who will experience a 7-day serious clinical event. Methods: Patients who presented to a single academic emergency department (ED) between 8 am and 10 pm with syncope or near-syncope were prospectively enrolled. Treating physicians recorded the presence or absence of all San Francisco Syncope Rule risk factors. Patients were contacted by telephone at 14 days for a structured interview. A 3-physician panel, blinded to the San Francisco Syncope Rule score, reviewed ED medical records, hospital records, and telephone interview forms to identify predefined serious clinical events. The primary outcome was the ability of the San Francisco Syncope Rule to predict any 7-day serious clinical event. A secondary outcome was the ability of the San Francisco Syncope Rule to predict 7-day serious clinical events that were not identified during the initial ED evaluation. Results: Of 592 eligible patients, 477 (81{\%}) provided informed consent. Direct telephone contact or admission/outpatient records were successfully obtained for 463 (97{\%}) patients. There were 56 (12{\%}) patients who had a serious 7-day clinical event, including 16 (3{\%}) who received a diagnosis after the initial ED evaluation. Sensitivity and specificity of the San Francisco Syncope Rule for the primary outcome were 89{\%} (95{\%} confidence interval [CI] 81{\%} to 97{\%}) and 42{\%} (95{\%} CI 37{\%} to 48{\%}), respectively, and 69{\%} (95{\%} CI 46{\%} to 92{\%}) and 42{\%} (95{\%} CI 37{\%} to 48{\%}), respectively, for the secondary outcome. Estimates of sensitivity were minimally affected by missing data and most optimistic assumptions for missing follow-up information. Conclusion: In this external validation cohort, the San Francisco Syncope Rule had a lower sensitivity and specificity than in previous reports.",
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