Diagnostic Test: San Francisco Syncope Rule

StudyParticipantsDiagnostic tests
Quinn 2008
prospective cohort study; study held in USA.

Setting: Emergency Department. ED of large university teaching hospital.

Funding: 1st author received an NIH grant.
Same authors developed SFSR - some potential for conflict of interest.
TLoC population: unselected patients. Prior tests: Unclear or Not stated.
Population details: ED patients with acute syncope or near syncope; use of electronic tracking system to identify all possible patients with appropriate tag terms

Definition of TLoC: syncope is a transient loss of consciousness with return to pre-existing neurologic function; near syncope not defined.

Inclusion criteria: acute syncope or near syncope.
Exclusion criteria: patients with trauma-associated or alcohol or illicit drug-related LoC; patients with a definite seizure; patients with LoC associated with an altered level of consciousness or persistent new neurologic defects.

Patient characteristics: age: mean 56 to 69 years; sex: 47–64% female;
Unclear/not stated with existing heart disease (); history of TLoC: not stated
Comorbidities: not stated. Other details: cause of syncope reported to be: cardiac 11%, neurologic 3%, orthostasis 12%, vasovagal 21%, medications 5%, psychiatric 1%, unclear 47%
Index test: San Francisco Syncope Rule: questionnaire on history of congestive heart failure; haemocrit < 30%; abnormal ECG result (any non-sinus rhythm or any new changes); patient complaint of shortness of breath; triage systolic bp < 90 mm Hg; time: in ED (n=1418, with 1474 visits)

Reference standard: Follow up and interpretation by 2 physicians to decide if the death was related to TLoC.
Online social security death index (checked in sample by direct follow up); confirmed by death certificate. No follow up for alive patients.; time 12 months (n=1418)
Other comparator tests: Physician decision to admit patient (n=684).

For target condition/outcome: Death that was possibly related to TLoC; 6 and 12 months reported

From: Appendix D1, Included studies characteristics

Cover of Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People
Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet].
NICE Clinical Guidelines, No. 109.
National Clinical Guideline Centre for Acute and Chronic Conditions (UK).
Copyright © National Clinical Guideline Centre for Acute and Chronic Conditions, 2010.

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