Abstract
Objective
To compare a clinical decision rule (San Francisco Syncope Rule [SFSR]) and physician
decision making when predicting serious outcomes in patients with syncope.
Methods
In a prospective cohort study, physicians evaluated patients presenting with syncope
and predicted the chance (0%-100%) of the patient developing a predefined serious
outcome. They were then observed to determine their decision to admit the patient.
All patients were followed up to determine whether they had a serious outcome within
7 days of their emergency department visit. Analyses included sensitivity and specificity
to predict serious outcomes for low-risk patients and comparison of areas under the
receiver operating characteristic curve for the decision rule, physician judgment,
and admission decisions.
Results
During the study period, there were 684 visits for syncope with 79 visits resulting
in serious outcomes. The area under the receiver operating characteristic curve was
0.92 (95% confidence interval [CI], 0.88-0.95) for the SFSR compared with physician
judgment 0.89 (95% CI, 0.85-0.93) and physician decision making 0.83 (95% CI, 0.81-0.87).
Physicians admitted 28% of patients in a low-risk group, with a median length of stay
of 1 day (interquartile range, 1-2.5 days). The SFSR had the potential to absolutely
decrease admissions by 10% in this low-risk group and still predict all serious outcomes.
Conclusions
Physician judgment is good when predicting which patients with syncope will develop
serious outcomes, but contrary to their judgment, physicians still admit a large number
of low-risk patients. The SFSR performs better than current physician performance
and has great potential to aid physician decision making.
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Article Info
Publication History
Accepted:
November 5,
2004
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
