Sun Benjamin C, Mangione Carol M, Merchant Guy, Weiss Timothy, Shlamovitz Gil Z, Zargaraff Gelareh, Shiraga Sharon, Hoffman Jerome R, Mower William R
Department of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073, USA.
Ann Emerg Med. 2007 Apr;49(4):420-7, 427.e1-4. doi: 10.1016/j.annemergmed.2006.11.012. Epub 2007 Jan 8.
We externally validate the ability of the San Francisco Syncope Rule to accurately identify syncope patients who will experience a 7-day serious clinical event.
Patients who presented to a single academic emergency department (ED) between 8 am and 10 pm with syncope or near-syncope were prospectively enrolled. Treating physicians recorded the presence or absence of all San Francisco Syncope Rule risk factors. Patients were contacted by telephone at 14 days for a structured interview. A 3-physician panel, blinded to the San Francisco Syncope Rule score, reviewed ED medical records, hospital records, and telephone interview forms to identify predefined serious clinical events. The primary outcome was the ability of the San Francisco Syncope Rule to predict any 7-day serious clinical event. A secondary outcome was the ability of the San Francisco Syncope Rule to predict 7-day serious clinical events that were not identified during the initial ED evaluation.
Of 592 eligible patients, 477 (81%) provided informed consent. Direct telephone contact or admission/outpatient records were successfully obtained for 463 (97%) patients. There were 56 (12%) patients who had a serious 7-day clinical event, including 16 (3%) who received a diagnosis after the initial ED evaluation. Sensitivity and specificity of the San Francisco Syncope Rule for the primary outcome were 89% (95% confidence interval [CI] 81% to 97%) and 42% (95% CI 37% to 48%), respectively, and 69% (95% CI 46% to 92%) and 42% (95% CI 37% to 48%), respectively, for the secondary outcome. Estimates of sensitivity were minimally affected by missing data and most optimistic assumptions for missing follow-up information.
In this external validation cohort, the San Francisco Syncope Rule had a lower sensitivity and specificity than in previous reports.
我们对外验证旧金山晕厥规则准确识别将经历7天严重临床事件的晕厥患者的能力。
前瞻性纳入上午8点至晚上10点间因晕厥或近乎晕厥到单一学术急诊科就诊的患者。主治医生记录所有旧金山晕厥规则风险因素的有无。在第14天通过电话对患者进行结构化访谈。一个由3名医生组成的小组，在不知道旧金山晕厥规则评分的情况下，查阅急诊病历、医院记录和电话访谈表格，以确定预定义的严重临床事件。主要结局是旧金山晕厥规则预测任何7天严重临床事件的能力。次要结局是旧金山晕厥规则预测在初始急诊评估中未识别出的7天严重临床事件的能力。
在592名符合条件的患者中，477名（81%）提供了知情同意书。成功获取了463名（97%）患者的直接电话联系信息或住院/门诊记录。有56名（12%）患者发生了7天严重临床事件，其中16名（3%）在初始急诊评估后得到诊断。旧金山晕厥规则对主要结局的敏感性和特异性分别为89%（95%置信区间[CI]81%至97%）和42%（95%CI 37%至48%），对次要结局分别为69%（95%CI 46%至92%）和42%（95%CI 37%至48%）。敏感性估计受缺失数据的影响最小，且对缺失随访信息的假设最为乐观。
在这个外部验证队列中，旧金山晕厥规则的敏感性和特异性低于先前报告。
