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In Reply: letter to the editor on ‘Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement’
  1. Giorgio Costantino1,2,
  2. Monica Solbiati1,2,
  3. Giovanni Casazza2
  1. 1 UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  2. 2 Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
  1. Correspondence to Dr Giorgio Costantino, UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Lombardia, Italy; giorgic2{at}

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We would like to thank Dr Thiruganasambandamoorthy for his comment that let us clarify some important aspects of our work.1

We agree with Dr Thiruganasambandamoorthy that the recommended number of patients with events and non-events for validating a previous multivariable regression analysis is higher than our population.2 However, since our aim was not to validate the regression model, but the score itself, the sample size would influence the precision of the estimates of sensitivity and specificity only. In this context, overfitting is not an issue.3

Our results show that the sensitivity of the Canadian Syncope Risk Score (CSRS) in low-risk patients is 70% with a 95% CI from 54% to 83%, which, in the worst (54%) but …

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  • Handling editor Richard Body

  • Contributors MS and GCo drafted the manuscript; all the authors critically revised the manuscript for important intellectual content; GCa provided statistical expertise.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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