San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio risk score, and clinical judgment in the assessment of short-term outcome of syncope

Franca Dipaola, Giorgio Costantino, Francesca Perego, Marta Borella, Andrea Galli, Giulia Cantoni, Franca Barbic, Francesco Casella, Pier Giorgio Duca, Raffaello Furlan

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The study aimed to compare the efficacy of the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score, San Francisco Syncope Rule, and clinical judgment in assessing the short-term prognosis of syncope. Methods: We studied 488 patients consecutively seen for syncope at the emergency department of 2 general hospitals between January and July 2004. Sensitivity, specificity, predictive values, and likelihood ratios for short-term (within 10 days) severe outcomes were computed for each decision rule and clinical judgment. Severe outcomes comprised death, major therapeutic procedures, and early readmission to hospital. Results: Clinical judgment had a sensitivity of 77%, a specificity of 69%, and would have admitted less patients (34%, P <.05 vs decision rules). The OESIL risk score was characterized by a sensitivity of 88% and a specificity of 60% (admission 43%). San Francisco Syncope Rule sensitivity was 81% and specificity was 63% (admission 40%). According to both clinical rules, no discharged patient would have died. With combined OESIL risk score and clinical judgment, the probability of adverse events was 0.7% for patients with both low risk scores, whereas that for both high risk scores was roughly 16%. Conclusion: Because of a relatively low sensitivity, both risk scores were partially lacking in recognizing patients with short-term high-risk syncope. However, the application of the decision rules would have identified all patients who subsequently died, and OESIL risk score and clinical judgment combined seem to improve the decision-making process concerning the identification of high-risk patients who deserve admission.

Original languageEnglish
Pages (from-to)432-439
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume28
Issue number4
DOIs
Publication statusPublished - May 2010

ASJC Scopus subject areas

  • Emergency Medicine

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