CJEM Articles: syncope
Displaying 1-2 of 2 results
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March
2009
11
2
Charles E. Murphy, Daniel McDermott, James V. Quinn
Objective: We sought to determine the incidence of acute myocardial infarction (AMI) in emergency department (ED) patients with syncope, the characteristics of these AMIs and how helpful the initial electrocardiogram (ECG) was in identifying these cases.
Methods: In a prospective cohort of consecutive patients with syncope, the initial ECG was found to be abnormal using a prespecified definition (any nonsinus rhythm or any new or age- indeterminate abnormalities). Patients were then followed up to identify an AMI diagnosed within 30 days of presentation.
Results: There were 1474 consecutive patient visits for syncope or near-syncope over a 45-month period spanning from Jul. 1, 2000, to Feb. 28, 2002, and Jul. 15, 2002, to Aug. 31, 2004, of which 46 (3.1%) were diagnosed with AMI. The majority of the AMI patients (42) had no ST segment elevation. The initial ECG was abnormal in 37 out of 46 cases. The diagnostic performance of the initial ECG was sensitivity 80% (95% confidence interval [CI] 67%-89%), specificity 64% (95% CI 61%-67%), negative predictive value 99% (95% CI 98%-100%), positive predictive value 7% (95% CI 6%-8%), positive likelihood ratio 2.2 (95% CI 1.6-2.5) and negative likelihood ratio 0.3 (95% CI 0.2-0.5).
Conclusion: The incidence of AMI in patients presenting with syncope is low. A normal ECG has a high negative predictive value, although its sensitivity is limited.
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May
2007
9
3
Anne-Maree Kelly, Debra Kerr, Teresa M. Cosgriff
Objective: The San Francisco Syncope Rule (SFSR) aims to identify patients with syncope who are at risk for short-term serious adverse outcomes. It has been reported to have high sensitivity and the potential to decrease admission rates. The aim of this study was to validate the SFSR in the Australasian setting.
Methods: Our prospective, observational cohort study identified patients with syncope using emergency department (ED) databases. Data, including demographics, the presence of SFSR predictors and ED disposition, were collected either during ED stay or by explicit medical record review. Patients were followed up after 7 days for defined serious outcomes (i.e., death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage or unplanned ED re-presentation). We analyzed sensitivity, specificity, and positive and negative predictive values. We compared the results with current physician-based clinical practice.
Results: We studied 89 patients with a median age of 74 years. Of them, 42% were male and the admission rate was 39%. Ten patients (11%) suffered a serious event. The SFSR was 90% sensitive (95% confidence interval [CI] 60%-98%) and 57% specific (95% CI 46%-67%) for predicting patients with a defined serious adverse event. The SFSR also categorized 48% of patients as "high risk." If the SFSR had been strictly applied, the admission rate would have increased by 9% and 1 serious adverse event would have been missed.
Conclusion: The SFSR demonstrated 90% sensitivity in this validation study. Strict application of the SFSR would have increased hospital admissions but would not have identified all adverse outcomes. In our setting, clinician judgement performed as well as the syncope rule, with a baseline admission rate of 36%.
