The Risk stratification Of XXXX in the Emergency department (ROSE) pilot study: a comparison of existing @entity1163 guidelines.

@entity1 @entity341 @entity1163
AIMS: This study was conducted as a feasibility pilot for the Risk stratification Of @entity1163 in the Emergency department (ROSE) study. The secondary aim was to compare the performance of our existing @entity341 ( @entity341 ) guidelines with existing clinical decision rules (Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) Score and San Francisco @entity1163 Rule; SFSR) at predicting short-term (1 week and 1 month) and medium-term (3 months) serious outcomes for @entity1 with @entity1163 presenting to the @entity341 . METHODS: This was a prospective cohort study. All @entity1 presenting with @entity1163 aged > or = 16 years between 7 November 2005 and 7 February 2006 were prospectively enrolled. RESULTS: 99 @entity1 were recruited over a 3-month period. 44 @entity1 were admitted and 55 discharged from the @entity341 . 11 @entity1 had a serious outcome: 8 by 7 days and a further 3 by 3 months. Five @entity1 died by 3 months and six others had an alternative serious outcome. All 11 @entity1 had been admitted from the @entity341 , 7 were at high risk, 4 were at medium risk and none were at low risk according to our existing @entity341 guidelines. Percentages of serious outcomes were 0%, 2.9%, 8.0%, 22.7% and 37.5% for OESIL scores of 0, 1, 2, 3 and 4 respectively. 40 @entity1 had none of the 5 SFSR high-risk factors (0 serious outcomes = 0%) and 59 @entity1 had an SFSR high-risk factor (11 serious outcomes = 18.6%). The risk of serious outcome at 7 days, 1 month and 3 months was 8.1%, 8.1% and 11.1%, respectively. CONCLUSIONS: A study to derive and validate a UK @entity341 @entity1163 clinical decision rule is feasible. This pilot study has evaluated the OESIL score, the SFSR and our existing @entity341 guidelines, and has shown that each is able to identify an increased probability of medium-term serious outcome in @entity1 with @entity1163 . The SFSR shows good sensitivity at the expense of an increase in admissions to hospital; however, our existing @entity1163 and the OESIL Score, although being able to successfully risk stratify @entity1 , are not sufficiently sensitive to be able to reduce admissions without missing @entity1 at risk of a serious outcome. Undoubtedly there is a need for a simple UK-derived clinical decision rule for @entity1 presenting with @entity1163 to enable safe, effective clinical care and to aid less experienced decision makers.
