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Please join us for conference this Wednesday in the 8th floor conference room at Elmhurst. We begin the day with Journal Club - please be prepared!

9a - Journal Club - Dr. Vashi (links below)
10a - Interesting Case Conference - Dr. Sarohia
11a - Trauma Conference - Dr. Weingart
12p - Joint Commission Update - Dr. Halbach
1p - M&M - Dr. Green

Anita has chosen 3 articles to review and requests that everyone comes prepared.
Residents as usual the journal articles are behind the normal logon and password.

PGY1s and 2s: Reed et al. The ROSE (Risk Stratification of Syncope in the Emergency Department) Study J ACC 2010;55(8):713-721. Paper.

PGY3s and 4s: Del Rosso et al. Clinical Predictors of Cardiac Syncope at Initial Evaluation in Patients Referred Urgently to a General Hospital: the EGSYS Score Heart. 2008;94:1620-26. Paper.

All: McGinn et al. User’s Guide to the Medical Literature XXII:How to Use Articles About Clinical Decision Rules JAMA. 2000;284(1):79-84. Paper.

This month's Annals (May 2006) has an article from Quinn et al. (QuinnAEM-5-06) purporting to validate the San Fransisco Syncope Rule. Also known as "CHESS", the "rule" is positive if any one of the following is true:

• CHF in the past medical history
• Hematocrit < 30
• EKG shows nonsinus rhythm or new changes
• Shortness of Breath
• Systolic < 90 mmHg

In a prospective cohort series, the rule was 98% sensitive (95%CI = 89-100%), 56% specific in predicting "adverse events" within 30 days. Basically, scoring a negative on the San Fransisco rule can make you feel better about sending a patient home. Though, let's be honest, if the test is really 89% sensitive (as the confidence interval allows) than this rule creates an "unnaceptably high" rate of serious outcomes. More below!

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