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 ECG
• 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 such as death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing a return Emergency Department visit and hospitalization for a related event.
SFSR has a sensitivity of 74-98% and specificity of 56%.[1] [2] This means that in patients with none of the above criteria, 74-98% had no serious outcome and may be considered as suitable candidates for outpatient monitoring. 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
- ↑ Quinn J, McDermott D, Stiell I, Kohn M, Wells G (May 2006). "Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes". Ann Emerg Med 47 (5): 448–54. doi:10.1016/j.annemergmed.2005.11.019. PMID 16631985.
- ↑ Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ (February 2008). "Failure to Validate the San Francisco Syncope Rule in an Independent Emergency Department Population". Ann Emerg Med 52 (2): 151–9. doi:10.1016/j.annemergmed.2007.12.007. PMID 18282636.
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