fainting fit a transient loss of co...

fainting fit a transient loss of consciousness followed on full recovery, is common unless difficult to manage. Even after a total evaluation, in many cases there is no clear reason for elision However, up to 30 percent of high-risk patients die within the first year. Risk stratification of patients can help direct the clinical evaluation. Although guidelines are available to help identify patients who are at higher risk for adverse results they have not been studied prospectively.

Quinn and associates used a prospective inquiry at a single hospital, following patients presenting to the push department with syncope or near elision to derive the San Francisco fainting fit Rule. Enrolled patients were followed for seven days to identify any serious issues Predictor variables--historical, related to the physical examination, and diagnostic tests--were studied. Serious issues were defined as death, myocardial infarction, arrhythmia, pulmonary embolism, reverse subarrachnoid hemorrhage, significant hemorrhage, or any other conclusion likely to bring the patient back to the strait department.

Of the 684 patients with swoon 79 (11.5 percent) developed serious issues by day 7. During the contemplation 55 percent of all patients presenting to the crisis department with syncope were admitted to the hospital. Of the 50 predictor variables analyzed, 26 (52 percent) were significantly associated with a serious issue Using multivariate analysis, a wager of prediction variables was identified that could improve the prediction of serious consequences (see accompanying table). In the studious mood population, this rule had a 962 percent sensitivity for identifying patients who had a serious result and a specificity of 619 percent It is estimated that use of this command would place about 45 percent of patients with swoon in the high-risk category, which might decrease the number of patients requiring hospital admission.

The authors terminate that using the San Francisco elision Rule to predict serious issues of syncope will help physicians determine which patients must be admitted.

Further prospective validation is commended before physicians actively use this decision direction in practice.

In an editorial in the same journal, Gallagher supports the methodology used to derive the San Francisco fainting fit Rule. The rule has 96 percent sensitivity, unless the dilemma is how to manage the the same syncope patient out of 25 (4 percent) who is at risk for serious issues but is not identified as as it is by this decision rule. This limitation illustrates the ne to use this behavior once it is validated, as a tool that helps with decision making on the contrary not as a basis for dictating binary action because of its lack of 100 percent sensitivity.

San Francisco elision Rule: CHESS

History of Congestive heart failure

Hematocrit les than 30 percent

Abnormal ECG (not sinus verse or new changes compared with the previous ECG)

Complaint of Shortness of breath

A triage Systolic family pressure of less than 90 mm Hg

ECG = electrocardiography.

RICHARD SADOVSKY, MD

Quinn JV et al. Derivation of the San Francisco elision Rule to predict patients with short-term serious consequences Ann Emerg Med February 2004;43:224-32 and Gallagher EJ Shooting an elephant [Editorial]. Ann Emerg M February 2004;43:233-7

COPYRIGHT 2004 American Academy of Family Physicians

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