Quinn et al developed the San Francisco Syncope Rule to identify patients who come to the Emergency Department with syncope who have a significant risk for an adverse short-term outcome. This can help identify those patients who may benefit from additional testing or a period of observation. The authors are from the University of California San Francisco and the University of Ottawa.
Adverse short-term outcomes (within the next 7 days):
(1) death
(2) cardiac arrhythmia
(3) pulmonary embolism
(4) stroke
(5) subarachnoid hemorrhage
(6) significant hemorrhage
(7) any condition requiring a return to the ED or hospitalization (pretty broad!)
Factors associated with increased short-term risk:
(1) abnormal ECG (rhythm other than sinus, new changes, other)
(2) shortness of breath
(3) systolic blood pressure < 90 mm Hg
(4) hematocrit < 30%
(5) congestive heart failure
|
Parameter
|
Finding
|
Points
|
|
ECG findings
|
normal
|
0
|
|
|
significant abnormality
|
1
|
|
shortness of breath
|
absent
|
0
|
|
|
present
|
1
|
|
systolic blood pressure
|
>= 90 mm Hg
|
0
|
|
|
< 90 mm Hg
|
1
|
|
hematocrit
|
>= 30%
|
0
|
|
|
< 30%
|
1
|
|
congestive heart failure
|
absent
|
0
|
|
|
present
|
1
|
total number of risk factors =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• If none of these factors is present, then the person was at low risk (0.8%).
• If at least one of these factors is present, then the person has a 25% of an adverse short-term outcome.
Performance (Quinn 2006):
• The sensitivity was 98% with a specificity of 56%.
