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J Korean Soc Emerg Med > Volume 23(2); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(2): 235-241.
Retrospective Validation of the San Francisco Syncope Rule for Predicting Serious Outcomes in a Korean Emergency Department
Mi Ok Shin, Tae Kyung Kang, Hye Jin Kim, Sung Chan Oh, Suk Jin Cho, Sang Lae Lee, Seok Yong Ryu
Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea. ryuchoi64@paik.ac.kr
Syncope in a common condition that is typically benign but is occasionally associated with mortality. We conducted a retrospective validation of the San Francisco Syncope Rule (SFSR) for use in identifying emergency department (ED) syncope patients with short-term serious outcomes.
We studied 131 syncope patients who were admitted to or visited the out-patient department within 1 month of an ED visit related to syncope from January to December 2010. Patients meeting the inclusion criteria as defined in the SFSR derivation were evaluated for 5 previously derived predictor variables: abnormal electrocardiography (ECG), shortness of breath, hematocrit <30%, triage systolic blood pressure <90 mm Hg, and a history of congestive heart failure. Predetermined outcome measures as defined by the SFSR included death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing or likely to cause a return ED visit and hospitalization, or related event.
The patient group consisted of 63 males and 68 females with an average age of 56 years. 35(26.7%) patients met the predetermined criteria for serious outcome. 10 of 35(28.6%) patients with a serious outcome were not identified as high risk using the rule. The rule performance for predicting serious outcomes included a sensitivity of 71.4% (95% confidence interval (CI), 56% to 86%), specificity of 69.8% (95% confidence interval (CI), 69% to 70%) and positive predictive value of 47.3%.
In this retrospective validation study in Korea, the SFSR performed with comparable specificity but with significantly lower sensitivity than reported in the original study. Implementing the rule would significantly increase admission rates.
Key words: Syncope, Predictive value of test, Sensitivity and specificity
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