Syncope: Emergency Department Evaluation and Disposition: The San Francisco Syncope Rule

San Francisco Syncope Rule

C ongestive heart failure history

H ematocrit <>

E CG abnormal (non-sinus rhythm, or new changes compared with old ECG)

S hortness of breath

S ystolic blood pressure <90

These criteria are easily recalled by using the mnemonic "CHESS".The criteria demonstrated 96% sensitivity (95% confidence interval [CI], 92% to 100%) and 62% specificity (95% CI, 58% to 66%) for serious outcomes at 7 days. It is useful tool to assess patient in ED. Either one criteria present during assesment it reflect the serious outcomes. Age is an important consideration. Some have argued that this study's result should not be applied to those over 65. If age >75 was added sensitivity increases to close to 100% but sensitivity drops to 44%.

Serious Outcomes as Defined by the San Francisco Syncope Rule

Death

Myocardial infarction

Arrhythmia (on monitor and tied to the syncopal event)

Pulmonary embolism

Stroke

Subarachnoid hemorrhage

Significant hemorrhage (tied to syncope and requiring transfusion)

Any condition causing return to the ED and hospitalization for related event