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San Francisco Syncope Rule

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1. Can the San Francisco Syncope Rule Predict Short-term Serious Outcomes in Patients Presenting With Syncope?

Can the San Francisco Syncope Rule Predict Short-term Serious Outcomes in Patients Presenting With Syncope? SystematicReviewSnapshot TAKE-HOME MESSAGE The San Francisco Syncope Rule is not suf?ciently sensitive to exclude serious outcomes; however, if there is no identi?ed cause for the syncope, the risk of serious short-term events is quite low. METHODS DATA SOURCES The authors performed a system- atic electronic search of MEDLINE, EMBASE, Med-Pilot, Cumulative Index to Nursing and Allied (...) - ing the accuracy of the San Fran- cisco Syncope Rule to predict the combined serious outcomes within 30 days in patients pre- senting to the ED with syncope. DATA EXTRACTION AND SYNTHESIS Methodological quality was as- sessed with the Quality Assess- ment of Diagnostic Accuracy Studies (QUADAS) tool and an extended checklist developed by Can the San Francisco Syncope Rule Predict Short-Term Serious Outcomes in Patients Presenting With Syncope? EBEM Commentators Gregory R. Snead, MD Lee G. Wilbur

2013 Annals of Emergency Medicine Systematic Review Snapshots

2. San Francisco Syncope Rule

San Francisco Syncope Rule San Francisco Syncope Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 San Francisco Syncope Rule San (...) Francisco Syncope Rule Aka: San Francisco Syncope Rule , CHESS Criteria From Related Chapters II. Indications Evaluation Evaluate short-term risk of serious outcome May reduce hospitalization rate III. Criteria (Mnemonic: CHESS) history <30% abnormal Systolic <90 mmHg at triage IV. Interpretation Positive: One of criteria above V. Efficacy: Risk for short-term serious Syncope outcome (30 day mortality) : 96% (misses 4% of cases) : 62% VI. References Images: Related links to external sites (from Bing

2018 FP Notebook

3. Validation of the San Francisco Syncope Rule in two hospital emergency departments in an Asian population (Abstract)

Validation of the San Francisco Syncope Rule in two hospital emergency departments in an Asian population The objective was to externally validate the ability of the San Francisco Syncope Rule (SFSR) to accurately identify patients who will experience a 7-day serious clinical event in an Asian population.This was a prospective cohort study, with a sample of adult patients with syncope and near-syncope enrolled. Patients 12 years old and below and patients with loss of consciousness after head (...) performed with a sensitivity of 94.2% (95% confidence interval [CI] = 89.0% to 97.0%) and a specificity of 50.8% (95% CI = 47.7% to 53.8%).In this study, SFSR rule had a sensitivity of 94.2%. This suggests caution on the strict application of the rule to all patients presenting with syncope. It should only be used as an aide in clinical decision-making in this population.© 2013 by the Society for Academic Emergency Medicine.

2013 EvidenceUpdates

4. The San Francisco Syncope Rule did not accurately predict serious short-term outcome in patients with syncope

The San Francisco Syncope Rule did not accurately predict serious short-term outcome in patients with syncope The San Francisco Syncope Rule did not accurately predict serious short-term outcome in patients with syncope | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username (...) and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here The San Francisco Syncope Rule did not accurately predict serious short-term outcome in patients with syncope Article Text Clinical prediction guide The San Francisco

2009 Evidence-Based Medicine

5. San Francisco Syncope Rule

San Francisco Syncope Rule San Francisco Syncope Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 San Francisco Syncope Rule San (...) Francisco Syncope Rule Aka: San Francisco Syncope Rule , CHESS Criteria From Related Chapters II. Indications Evaluation Evaluate short-term risk of serious outcome May reduce hospitalization rate III. Criteria (Mnemonic: CHESS) history <30% abnormal Systolic <90 mmHg at triage IV. Interpretation Positive: One of criteria above V. Efficacy: Risk for short-term serious Syncope outcome (30 day mortality) : 96% (misses 4% of cases) : 62% VI. References Images: Related links to external sites (from Bing

2015 FP Notebook

6. What Is the Diagnostic Accuracy of Cardiac Biomarkers for the Prediction of Adverse Cardiac Events in Patients Presenting With Acute Syncope? (Full text)

for syncope in the emergency department: a systematic review and meta-analysis. Ann Emerg Med . 2010 ; 56 : 362–373 The San Francisco Syncope Rule is the most robustly studied decision rule, and it has a pooled sensitivity and specificity of 86% (95% CI 83% to 89%) and 49% (95% CI 48% to 91%), respectively, for adverse events and the inability to reduce admission rates in some ED locations. x 6 Serrano, L.A., Hess, E.P., Bellolio, M.F. et al. Accuracy and quality of clinical decision rules for syncope (...) in the emergency department: a systematic review and meta-analysis. Ann Emerg Med . 2010 ; 56 : 362–373 , x 7 Birnbaum, A., Esses, D., Bijur, P. et al. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med . 2008 ; 52 : 151–159 , x 8 Thiruganasambandamoorthy, V., Hess, E.P., Alreesi, A. et al. External validation of the San Francisco Syncope Rule in the Canadian setting. Ann Emerg Med . 2010 ; 55 : 464–472 Ideally, a syncope patient having

2019 Annals of Emergency Medicine Systematic Review Snapshots PubMed abstract

7. San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review (Full text)

San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review The San Francisco Syncope Rule has been proposed as a clinical decision rule for risk stratification of patients presenting to the emergency department with syncope. It has been validated across various populations and settings. We undertook a systematic review of its accuracy in predicting short-term serious outcomes.We identified studies by means of systematic searches in seven electronic databases from (...) inception to January 2011. We extracted study data in duplicate and used a bivariate random-effects model to assess the predictive accuracy and test characteristics.We included 12 studies with a total of 5316 patients, of whom 596 (11%) experienced a serious outcome. The prevalence of serious outcomes across the studies varied between 5% and 26%. The pooled estimate of sensitivity of the San Francisco Syncope Rule was 0.87 (95% confidence interval [CI] 0.79-0.93), and the pooled estimate of specificity

2011 EvidenceUpdates PubMed abstract

8. BNP in the Evaluation of Syncope

, respectively, and the rule was derived and validated at a single study site, requiring additional validation at multiple sites before it can be used safely. Previously, the San Francisco syncope rule was validated at a single site, but then . Two additional prospective studies evaluating the diagnostic accuracy of BNP or its analogs were reviewed. The first of these ( ) enrolled patients with syncope admitted to a cardiac unit in Cologne, Germany. They evaluated the accuracy of NT-pro-BNP for identifying (...) Article 1: Article 2: Article 3: Article 4: Bottom Line Syncope is a with a , ranging from the very benign (e.g. vasovagal syncope, orthostasis) to potentially life-threatening causes (e.g. cardiac arrhythmia). While studies have demonstrated a broad range for rates of serious outcomes, , there is very little objective data to help the emergency physician determine who is safe for discharge and who requires admission to prevent morbidity and mortality. Several clinical prediction rules have been

2018 Washington University Emergency Medicine Journal Club

9. Syncope: what (if any) investigations are required?

majority of these have had significant issues associated with their potential use, and have therefore not been widely disseminated. San Francisco Syncope Rule (SFSR): Examined the prediction of serious adverse events (SAE’s) but performed poorly on external validation. Risk Stratification of Syncope (ROSE): Predicted SAE at 30 days, but performed sub-optimally on external validation and requires the utilization of BNP. Short term Prognosis in Syncope (StEPS): identified risk factors for death (...) <50, with a vasovagal predisposition and no known cardiac disease), and found that the above investigations did not contribute to the diagnosis in any of these patients [21] . Subsequently, it seems that there is low potential yield of investigations, and those with positive results are not likely to be well afterwards, or will have significant medical comorbidities. There have been a multitude of decision rules released to help us in our approach to the patient with syncope, however, the vast

2018 CandiEM

10. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (Full text)

, Osservatorio Epidemiologico sulla Sincope nel Lazio; ROSE, Risk Stratification of Syncope in the ED; SCD, sudden cardiac death; SFSR, San Francisco Syncope Rule; STePS, Short-Term Prognosis of Syncope Study; TIA, transient ischemic attack; VA, ventricular arrhythmias; and VHD, valvular heart disease. 2.3.4. Disposition After Initial Evaluation: Recommendations The evaluating provider must decide whether further workup can continue in an outpatient setting or whether hospital-based evaluation is required (...) Events Predictors NPV (%) Martin 1997 252 104 (41%) 1-y death/arrhythmia Yes Abnormal ECG ; >45 y of age; VA; HF 93 Sarasin 2003 175 30 (17%) Inpatient arrhythmia Yes Abnormal ECG ; >65 y of age; HF 98 OESIL 2003 270 31 (11%) 1-y death N/A Abnormal ECG ; >65 y of age; no prodrome; cardiac history 100 SFSR 2004 684 79 (12%) 7-d serious events Yes Abnormal ECG ; dyspnea; hematocrit; systolic BP <90 mm Hg; HF 99 Boston Syncope Rule 2007 293 68 (23%) 30-d serious events Yes Symptoms of acute coronary

2017 American Heart Association PubMed abstract

11. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society (Full text)

dissection, stroke/TIA, cerebral hemorrhage, or significant anemia requiring blood transfusion. AVB indicates atrioventricular block; BBB, bundle-branch block; BP, blood pressure; ECG, electrocardiogram; ED, emergency department; HF, heart failure; MI, myocardial infarction; N/A, not available; NPV, negative predictive value; O 2 Sat, oxygen saturation; OESIL, Osservatorio Epidemiologico sulla Sincope nel Lazio; ROSE, Risk Stratification of Syncope in the ED; SCD, sudden cardiac death; SFSR, San (...) Francisco Syncope Rule; STePS, Short-Term Prognosis of Syncope Study; TIA, transient ischemic attack; VA, ventricular arrhythmias; and VHD, valvular heart disease. Table 6. Examples of Serious Medical Conditions That Might Warrant Consideration of Further Evaluation and Therapy in a Hospital Setting Cardiac Arrhythmic Conditions Cardiac or Vascular Nonarrhythmic Conditions Noncardiac Conditions Sustained or symptomatic VTSymptomatic conduction system disease or Mobitz II or third-degree heart

2017 American Heart Association PubMed abstract

12. Syncope: Guideline For Evaluation and Management of Patients With

anemia requiring blood transfusion. AVBindicatesatrioventricularblock;BBB,bundle-branchblock;BP,bloodpressure;ECG,electrocardiogram;ED,emergencydepartment;HF,heartfailure;MI,myocardialinfarction; N/A,notavailable;NPV,negativepredictivevalue;O2Sat,oxygensaturation;OESIL,OsservatorioEpidemiologicosullaSincopenelLazio;ROSE,RiskStrati?cationofSyncopeintheED; SCD, sudden cardiac death; SFSR, San Francisco Syncope Rule; STePS, Short-Term Prognosis of Syncope Study; TIA, transient ischemic attack; VA (...) is obtained), rules out true syncope and most forms of epilepsy (227–229). In 1 study of 800 patients who underwent tilt-table testing, approximately 5% were diagnosed with pseudosyncope. Compared with patients with VVS, eye closure during the event, long periods of apparent transient loss of consciousness, and increased heart rate and blood pressure are highly speci?c for pseudosyncope. One study of 21 patients with suspected pseudosyncope who were subjected to tilt-table testing with continuous

2017 American College of Cardiology

13. Comparison of existing syncope rules and newly proposed anatolian syncope rule to predict short-term serious outcomes after syncope in the Turkish population (Full text)

Comparison of existing syncope rules and newly proposed anatolian syncope rule to predict short-term serious outcomes after syncope in the Turkish population We wished to compare the San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in Syncope Study (EGSYS) and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk scores and to assess their efficacy in recognising patients with syncope at high risk for short-term adverse events (death, the need for major therapeutic (...) procedures, and early readmission to the hospital). We also wanted to test those variables to designate a local risk score, the Anatolian Syncope Rule (ASR).This prospective, cohort study was conducted at the emergency department of a tertiary care centre. Between December 1 2009 and December 31 2010, we prospectively collected data on patients of ages 18 and over who presented to the emergency department with syncope.We enrolled 231 patients to the study. A univariate analysis found 23 variables

2012 International journal of emergency medicine PubMed abstract

14. CRACKCast E015 – Syncope

edition. Chapter 15 – page 137. 3) Describe the San Francisco Syncope Rule 5 points: History CHF Hematocrit <30% Abnormal ECG SOB on history SBP <90 at triage 4) What are red flags that require admission in syncope? Absolute: chest pain unexplained SOB a hx of significant CHF or valvular disease patient with ECG evidence of ventricular dysrhythmias, ischemia, significantly prolonged QT intervals, or new BBB Relative red flags (consider admission): age > 45 pre-existing cardiovascular or congenital (...) CRACKCast E015 – Syncope CRACKCast E015 - Syncope - CanadiEM CRACKCast E015 – Syncope In , , by Adam Thomas November 24, 2016 This episode of CRACKCast covers Rosen’s Chapter 15, Syncope. This short but high yield chapter covers Syncope, a common reason for emergency visits that may be benign, but sometimes can have more sinister diagnoses lurking that cannot be missed! Rosen’s in Perspective: Syncope is defined as a sudden, transient, loss of consciousness with loss of postural tone

2016 CandiEM

15. External validation of the San Francisco Syncope Rule in the Canadian setting (Abstract)

External validation of the San Francisco Syncope Rule in the Canadian setting Syncope is a common disposition challenge for emergency physicians. Among the risk-stratification instruments available, only the San Francisco Syncope Rule is rigorously developed. We evaluate its performance in Canadian emergency department (ED) syncope patients.This retrospective review included patients aged 16 years or older who fulfilled the definition of syncope (transient loss of consciousness with complete (...) increase the admission rate from 12.3% to 69.5%.In this retrospective Canadian study, the San Francisco Syncope Rule performed with comparable sensitivity but significantly poorer specificity than previously reported. Implementing the rule would significantly increase admission rates. Further studies to either refine the San Francisco Syncope Rule or develop a new rule are needed.Copyright 2009. Published by Mosby, Inc.

2010 EvidenceUpdates

16. Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity (Full text)

maximum, QT minimum, QTpeak, QT corrected, QT dispersion and Tpeak-to-Tend interval were compared between two groups. The paper medical records were used for scoring with San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in SYncope Study (EGSYS) score and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score.Mean QTc (p < 0.0005), mean QTmax (p < 0.0005), mean QTdisp (p < 0.0005), mean QTpeak (p = 0.005) and mean TpTe (p = 0.018) were significantly longer in patients (...) with syncope compared with control subjects. A QTc > 424.8 ms (sensibility: 81.88 - specificity: 57.86) showed the greatest predictive value for diagnosis of syncope. On the EGSYS score and on the OESIL score, QTc was significantly prolonged in high-risk patients compared with low-risk patients. On the San Francisco Syncope Rule, QTc and QTdisp were significantly prolonged in high-risk patients compared with low-risk patients.Mean QTc, mean QTdisp, mean TpTe, mean QTmax and mean QTpeak were significantly

2014 EvidenceUpdates PubMed abstract

17. Predictors of mortality, rehospitalization for syncope, and cardiac syncope in 352 consecutive elderly patients with syncope. (Abstract)

for mortality were diabetes mellitus (OR 2.08; 95% CI 1.09-3.99, P = .0263), history of smoking (OR 2.23; 95% CI 1.10-4.49, P = .0255), and use of statins (OR 0.37; 95% CI 0.19-0.72, P = .0036). Independent risk factors for predicting a cardiac cause of syncope were an abnormal electrocardiogram (OR 2.58; 95% CI 1.46-4.57, P = .0012) and reduced ejection fraction (OR 2.92; 95% CI 1.70-5.02, P < .001). The San Francisco Syncope Rule and Osservatorio Epidemiologico sulla Sincope nel Lazio scores did (...) Predictors of mortality, rehospitalization for syncope, and cardiac syncope in 352 consecutive elderly patients with syncope. To investigate the etiologies of syncope and predictors of all-cause mortality, rehospitalization, and cardiac syncope in consecutive elderly patients presenting with syncope to our emergency department.Participants were 352 consecutive patients aged 65 years or older with syncope admitted to hospital from the emergency department.Observational retrospective study.Review

2013 Journal of the American Medical Directors Association

18. ED Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....

are common among older adults; etiologies range from benign to life-threatening. We determined the frequency, yield, and costs of tests obtained to evaluate older persons with syncope. We also calculated the cost per test yield and determined whether the San Francisco Syncope Rule (SFSR) improved test yield. Methods : Review of 2,106 consecutive patients 65 years and older admitted following a syncopal episode. Results : Electrocardiograms (99%), telemetry (95%), cardiac enzymes (95%), and head computed (...) for the rule to help with physician decision making. _____________________________________________________________________________ 13) Validation of SF Syncope Rule : Quinn et al. Annals 47(5):448-454, May 2006. Quinn J et al. Study objective: We prospectively validate the San Francisco Syncope Rule (history of congestive heart failure, Hematocrit Methods In a prospective cohort study, consecutive patients with syncope or near syncope presenting to an emergency department (ED) of a teaching hospital were

2015 Dr Smith's ECG Blog

19. Comparison of different risk stratification systems in predicting short-term serious outcome of syncope patients (Full text)

Comparison of different risk stratification systems in predicting short-term serious outcome of syncope patients Determining etiologic causes and prognosis can significantly improve management of syncope patients. The present study aimed to compare the values of San Francisco, Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL), Boston, and Risk Stratification of Syncope in the Emergency Department (ROSE) score clinical decision rules in predicting the short-term serious outcome (...) of syncope patients.The present diagnostic accuracy study with 1-week follow-up was designed to evaluate the predictive values of the four mentioned clinical decision rules. Screening performance characteristics of each model in predicting mortality, myocardial infarction (MI), and cerebrovascular accidents (CVAs) were calculated and compared. To evaluate the value of each aforementioned model in predicting the outcome, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio

2016 Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences PubMed abstract

20. Guidelines on Diagnosis and Management of Syncope

or vasodepressor syncope]. Knowing the various triggers is clinically important, as recognizing them may be instru- mental in diagnosing syncope: † ‘Vasovagal’ syncope (VVS), also known as the ‘common faint’, is mediated by emotion or by orthostatic stress. It is usually pre- ceded by prodromal symptoms of autonomic activation (sweat- ing, pallor, nausea). † ‘Situational’ syncope traditionally refers to re?ex syncope associ- ated with some speci?c circumstances. Post-exercise syncope can occur in young (...) sinus syndrome, the sinoatrial node is damaged, because of either abnormal automaticity or sinoatrial conduction abnormalities. In this situation syncope is due to long pauses caused by sinus arrest or sinoatrial block and a failure of escape mechanism. These pauses are most frequently encountered when an atrial tachyarrhythmia suddenly stops (brady-tachy syndrome). 19 As a rule, the more severe forms of acquired atrioventricular (AV) block (Mobitz II block, ‘high grade’, and complete AV block

2009 European Society of Cardiology

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