Division of Emergency Medicine Stanford University, Palo Alto, CA, USA.
Acad Emerg Med. 2011 Jul;18(7):714-8. doi: 10.1111/j.1553-2712.2011.01120.x.
To determine the sensitivity and specificity of the San Francisco Syncope Rule (SFSR) electrocardiogram (ECG) criteria for determining cardiac outcomes and to define the specific ECG findings that are the most important in patients with syncope.
A consecutive cohort of emergency department (ED) patients with syncope or near syncope was considered. The treating emergency physicians assessed 50 predictor variables, including an ECG and rhythm assessment. For the ECG assessment, the physicians were asked to categorize the ECG as normal or abnormal based on any changes that were old or new. They also did a separate rhythm assessment and could use any of the ECGs or available monitoring strips, including prehospital strips, when making this assessment. All patients were followed up to determine a broad composite study outcome. The final ECG criterion for the SFSR was any nonsinus rhythm or new ECG changes. In this specific study, the initial assessments in the database were used to determine only cardiac-related outcomes (arrhythmia, myocardial infarction, structural, sudden death) based on set criteria, and the authors determined the sensitivity and specificity of the ECG criteria for cardiac outcomes only. All ECGs classified as "abnormal" by the study criteria were compared to the official cardiology reading to determine specific findings on the ECG. Univariate and multivariate analysis were used to determine important specific ECG and rhythm findings.
A total of 684 consecutive patients were considered, with 218 having positive ECG criteria and 42 (6%) having important cardiac outcomes. ECG criteria predicted 36 of 42 patients with cardiac outcomes, with a sensitivity of 86% (95% confidence interval [CI] = 71% to 94%), a specificity of 70% (95% CI = 66% to 74%), and a negative predictive value of 99% (95% CI = 97% to 99%). Regarding specific ECG findings, any nonsinus rhythm from any source and any left bundle conduction problem (i.e., any left bundle branch block, left anterior fascicular block, left posterior fascicular block, or QRS widening) were 2.5 and 3.5 times more likely associated with significant cardiac outcomes.
The ECG criteria from the SFSR are relatively simple, and if used correctly can help predict which patients are at risk of cardiac outcomes. Furthermore, any left bundle branch block conduction problems or any nonsinus rhythms found during the ED stay should be especially concerning for physicians caring for patients presenting with syncope.
确定旧金山晕厥规则（SFSR）心电图（ECG）标准在确定心脏结局方面的敏感性和特异性，并确定晕厥患者中最重要的特定 ECG 发现。
连续纳入急诊科（ED）晕厥或近似晕厥患者。治疗 ED 医生评估了 50 个预测变量，包括 ECG 和节律评估。对于 ECG 评估，医生被要求根据新旧变化将 ECG 分类为正常或异常。他们还进行了单独的节律评估，并可以在进行此评估时使用任何 ECG 或可用的监测条，包括院前条。所有患者均进行随访以确定广泛的综合研究结果。SFSR 的最终 ECG 标准是任何非窦性节律或新的 ECG 变化。在这项具体研究中，数据库中的初始评估仅用于根据既定标准确定与心脏相关的结果（心律失常、心肌梗死、结构性、猝死），作者确定了 ECG 标准对心脏结果的敏感性和特异性。研究标准分类为“异常”的所有 ECG 均与官方心脏病学读数进行比较，以确定 ECG 上的特定发现。使用单变量和多变量分析确定重要的特定 ECG 和节律发现。
共考虑了 684 例连续患者，其中 218 例心电图标准阳性，42 例（6%）有重要的心脏结局。ECG 标准预测了 42 例心脏结局患者中的 36 例，敏感性为 86%（95%CI=71%至 94%），特异性为 70%（95%CI=66%至 74%），阴性预测值为 99%（95%CI=97%至 99%）。关于特定的 ECG 发现，任何来源的非窦性节律和任何左束支传导问题（即任何左束支传导阻滞、左前束支阻滞、左后束支阻滞或 QRS 增宽）与严重的心脏结局相关的可能性增加 2.5 倍和 3.5 倍。
SFSR 的 ECG 标准相对简单，如果正确使用，可以帮助预测哪些患者有心脏结局的风险。此外，ED 期间发现的任何左束支传导阻滞问题或任何非窦性节律都应引起照顾晕厥患者的医生的特别关注。
