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.

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.

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.

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%.

Concern about youth violence in Canada is growing. Because victims of violence are more likely to become future violent perpetrators, preventative interventions are often based out of inpatient units; however, the question of how often youth who have been injured due to violence are discharged from emergency departments (EDs), or whether there are opportunities for emergency healthcare workers to deliver violence prevention programs, is not known. The primary objectives of this study were to describe the frequency and patterns of violent injuries among youth, to determine how many injured youth are discharged directly from EDs and to estimate the proportion of injured youth who may benefit from ED-based intervention programs.

We conducted an observational study using a population-based database that records information on all ED visits in Ontario. We analyzed age, sex, cause of injury and disposition for all patients aged 12–19 years who presented to Toronto EDs with violent injuries during a 2-year period (April 2002 to March 2004).

A total of 4100 patients aged 12–19 years visited Toronto EDs with violent injuries during the study period. Assault due to bodily force (in contrast to sharp objects, guns or other) was the most common injury mechanism, accounting for 48.7% of cases (95% confidence interval [CI] 47.1%–50.2%). The majority of patients (89.3%; 95% CI 88.3%–90.2%) were discharged directly from EDs, including 44% of gun-related injuries.

In Toronto, a large proportion (89.3%) of youth injured in violent incidents are discharged directly from EDs. There are opportunities to develop ED-based youth violence prevention initiatives.