Application of San Francisco Syncope Rule in elderly ED patients

Am J Emerg Med. 2008 Sep;26(7):773-8. doi: 10.1016/j.ajem.2007.10.042.


Objectives: The San Francisco Syncope Rule (SFSR) is a decision rule with the potential to identify patients at risk for serious outcomes within 7 days of the emergency department (ED) visit for syncope. The initial studies of the SFSR reported a high sensitivity and specificity for identifying patients, of all ages, with serious outcomes. Our objective was to determine if the SFSR can be safely and accurately applied to ED patients aged 65 and older with syncope or near-syncope.

Methods: A retrospective review of ED patients aged 65 years and older with syncope or near-syncope between January 2000 and August 2001 was performed. Charts were reviewed for evidence of SFSR risks for the ED visit and serious outcomes within 7 days of the ED visit.

Results: Of 773 subjects identified as having syncope or near-syncope, 517 subjects were included. There were 98 patients with serious outcomes. Twenty-three patients who were negative on SFSR had serious outcomes. The sensitivity and specificity of the SFSR were 76.5% (95% confidence interval [CI], 66.7%-84.3%) and 36.8% (95% CI, 32.2%-41.6%), respectively. The negative and positive predictive values were 87.0% (95% CI, 80.9%-91.4%) and 22.1% (95% CI, 17.8%-26.9%), respectively.

Conclusions: In our cohort of elderly ED patients, the SFSR had a lower sensitivity and specificity. The SFSR may not be applicable to the elderly ED population. Future prospective validation is necessary before application to the ED elderly population.

MeSH terms

  • Aged
  • Clinical Protocols
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Geriatric Assessment / methods*
  • Humans
  • Male
  • Medical Records
  • Multicenter Studies as Topic
  • Predictive Value of Tests
  • Retrospective Studies
  • Sensitivity and Specificity
  • Syncope / classification
  • Syncope / complications*
  • Syncope / diagnosis