Here is a quick look at two articles published in the October issue of Annals of Emergency Medicine. Visit www.annemergmed.com to read the full text.

Accuracy and Quality of Clinical Decision Rules for Syncope in the Emergency Department: A Systematic Review and Meta-analysis
By L Serrano, et al.

Editor’s Capsule Summary

• What is already known on this topic: Prediction rules have been proposed to assist in the identification of syncope patients at low risk for poor short-term outcomes.
• What question this study addressed: The authors performed a systematic review that included a meta-analysis of two syncope prediction rules for which multiple studies had been published.
• What this study adds to our knowledge: Performance of the rules was variable. Outcome rates in the low-risk groups ranged from 2% to 36% and from 5% to 13% with the San Francisco and the Osservatorio Epidemiologico sulla Sincope nel Lazio rules, respectively.
• How this is relevant to clinical practice: Clinicians should not rely solely on a prediction rule in deciding on the disposition of emergency department patients with syncope.

Improved Out-of-Hospital Cardiac Arrest Survival After the Sequential Implementation of 2005 AHA Guidelines for Compressions, Ventilations, and Induced Hypothermia: The Wake County Experience
By PR Hinchey, et al.

Editor’s Capsule Summary

• What is already known on this topic: The 2005 AHA Guidelines recommend chest compression before defibrillation for unwitnessed ventricular fibrillation/ventricular tachycardia and one shock versus three, and postresuscitation hypothermia induction, while deemphasizing ventilations.
• What question this study addressed: This 1,365-patient observational time-series measured survival-to-hospital-discharge in patients with ventricular fibrillation/ventricular tachycardia during a tiered implementation of the 2005 guidelines.
• What this study adds to our knowledge: In this urban/suburban EMS system, there was a doubling of survival between the pre- and post­implementation phases.
• How this is relevant to clinical practice: This paper provides support for the 2005 guidelines, but the findings should be confirmed in other systems and, ideally, with randomized trials.

From the College

The Board of Directors of the American College of Emergency Physicians issued on July 15, 2010, a public censure of James A.

Espinosa, M.D., FACEP, for violation of ACEP’s “Expert Witness Guidelines for the Specialty of Emergency Medicine” and the “Code of Ethics for Emergency Physicians.”