Prospective validation of San Francisco Syncope Rule in Indian population

Context: The San Francisco Syncope Rule (SFSR) was proposed as a risk stratification tool for patients presenting to the emergency department (ED) with syncope. Aims: The aim of this study was to validate the SFSR in Indian population for predicting serious outcomes in patients presenting with syncope or near syncope. Secondary aim was to identify whether the admission rate can be safely reduced by applying this rule in the ED. Settings and Design: This was a prospective observational study conducted among patients attending the ED of a teaching hospital with syncope or near syncope. Subjects and Methods: Physicians prospectively applied the SFSR after usual evaluation, and patients were followed up to determine whether they had a serious outcome within 30 days of their ED visit. Statistical Analysis Used: Sensitivity, specificity, positive and negative predictive values of the rule for predicting serious outcomes were calculated. Results: A total of 210 patients were included in the study. There were 86 (41%) males and 124 (59%) females. Average age was 60.6 years. A total number of patients admitted were 110 out of 210 patients (52%). At least one SFSR predictor was positive in 90 (43%) patients out of 210. A total of 23 patients (11%) had at least one serious outcome at 30 days of ED visit. SFSR had a sensitivity of 95.65% and a specificity of 63.64% to predict serious outcome in the study population. Conclusions: The SFSR is valid in Indian population and application of the rule could reduce the hospital admission rates for syncope