San Francisco Syncope Rule

The San Francisco Syncope Rule (SFSR) is a simple rule for evaluating the risk of adverse outcomes in patient who present with fainting or syncope.

The mnemonic for features of the rule is CHESS:

• C - History of congestive heart failure

• H - Hematocrit < 30%

• E - Abnormal EKG

• S - Shortness of breath

• S - Triage systolic blood pressure < 90

A patient with any of the above measures is considered at high risk for a serious outcome (death, MI, arrhythmia, PE, stroke, SAH, need for transfusion, return emergency department visits within 30 days).

SFSR has a sensitivity of 74-98% and specificity of 56%. [cite journal |author=Quinn J, McDermott D, Stiell I, Kohn M, Wells G |title=Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes |journal=Ann Emerg Med |volume=47 |issue=5 |pages=448–54 |year=2006 |month=May |pmid=16631985 |doi=10.1016/j.annemergmed.2005.11.019 |url=] [cite journal |author=Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ |title=Failure to Validate the San Francisco Syncope Rule in an Independent Emergency Department Population |journal=Ann Emerg Med |volume= |issue= |pages= |year=2008 |month=February |pmid=18282636 |doi=10.1016/j.annemergmed.2007.12.007 |url=] This means that 74-98% of patients who had a serious outcome had a positive test. This makes the test good for ruling out hospital admissions for patients with syncope.

Syncope accounts for 1-2% emergency department visits. Half are hospitalized and of these, 50% have unclear diagnosis and 85% will be simply monitored. Given these statistics, the SFSR will help reduce inefficient admissions.

References