Background• Syncope is usually a benign

symptom .• It is associated occasionally

with significant morbidity and mortality.

• As a result, syncope is often referred to a “low-risk / high-stakes” symptom.

• Many physicians admit these patients even though they believe are low risk because of the high stakes involved.

To prospectively validate in the ED, San Francisco Syncope Rule. (history of congestive heart failure, Hematocrit 30%, abnormal ECG result [new changes or non–sinus rhythm], complaint of shortness of breath, and systolic blood pressure 90 mm Hg during triage).

Aims & Objectives

• During study period, 371 patients visited ED with Syncope.

• The average age in study was 44 years with 77% predominantly being male patients.

• Overall admission rate was 100%.

• In our study, 13.7% of patients had definite serious outcomes (108) within 30 days.

• Fifty Four patients had serious outcomes during ED visit, and remaining 54 patients had serious outcome within next 30 days.

• Youngest patient was 10 years & oldest was 88 years old.

• Commonest presentation during ED visit was syncope followed by neurological deficits and then Chest pain.

• One Eighty Four were hypertensive and 147 Diabetic.

• Haematocrit changes alone did not make a significant difference as only 24 patients required blood transfusion.

Methods

ConclusionThe San Francisco Syncope Rule performed with high sensitivity and specificity in this validation cohort and is valuable tool to help risk stratify patients. It may help with physician decision making and improve use of hospital admission for syncope.

VALIDATION OF THE SAN FRANCISCO SYNCOPE RULE

TO PREDICT PATIENTS WITH SERIOUS OUTCOMES IN EMERGENCY DEPARTMENT

Dr. Nishanth Hiremath.S*; Dr. Srihari Cattamanchi; Dr. T.V. Ramakrishnan;Dr. Srinivas Reddy Banala; Dr. John Nobel Thomas.

Sri Ramchandra Medical College & Research Institute, Porur, Chennai – 600116. Tamil Nadu. India.

Results

Dr. Nishanth Hiremath, Address: ; Mobile: ; Email id:;

Design: A Prospective, analytical study.

Setting: Accident & Emergency Department, of Sri Ramachandra Medical College & Research Institute, a tertiary care, level I trauma centre in Chennai, India.

Duration: 1st January 2008 to 31st December 2009.

Instrument: A preformatted questionnaire used to collect demographic data, history of congestive heart failure, Haematocrit <30%, abnormal ECG result, shortness of breath, and a triage systolic blood pressure <90 mm Hg.

Statistical Analysis: The sensitivity and specificity, with 95% confidence intervals (CIs), were calculated using SPSS software Ver. 17.0.

Methodology: ER Physicians prospectively applied San Francisco Syncope Rule after their initial evaluation, and patients were followed up to determine whether they had predefined serious outcome within 30 days of their ED visit

Inclusion criteria: Patients presenting with or near syncope for their ED visit were considered for the study. Patients with altered consciousness or persistent new neurologic deficits were included.

Exclusion criteria: Loss of consciousness due to trauma, alcohol or drug abuse as well as patients with a definite seizure were excluded.

• Presenting ECG changes were seen in 209 patients (56%).

• Out of 26 patients on whom Holter was done 18 were positive and had significant p value 0.000

• All patients underwent Echo in which 247 had an abnormal echo.

• MRI brain was significant during the time of admission or within 30 days, as 71 patients had significant finding.

• Sixty Six Percent of patients were admitted in ICU.

• In period of 30 days, 259 patients were discharged, 40 patients were further investigated and 40 patients died in hospital.

• Eight patients were discharged against medical advice (DAMA).

• Among 259 patients discharged from hospital only 140 patients came for follow up.

• Remaining 119 were not traceable.

• High risk patients were about 179 patients (48%).

Risk Score Sensitivity Specificity Positive Predictive Value

Negative Predictive Vale

Hematocrit 100 53.4 6.7 100

ECG Changes

98.1 90.4 88.8 98.4

CHF 100 53.3 6.14 100SOB 100 63.1 37.4 100

• The Sanfrancisco syncope rule as a group had a highly significant p value (<.0001) but individually when the criteria was taken it is not statistically significant