ToolsCalculators
San Francisco Syncope Rule
Predicts 7-day serious outcomes after ED syncope (CHESS criteria).
San Francisco Syncope Rule
History of congestive heart failure
Hematocrit <30%
Abnormal ECG (new changes or non-sinus rhythm)
Complaint of shortness of breath
Triage systolic BP <90 mmHg
Result0 of 5 criteria positive
No criteria present — low risk for a serious outcome within 7 days.
When to use
- Risk-stratifying ED patients presenting with syncope or near-syncope for serious short-term outcomes.
Formula
High risk if any one of 5 criteria (CHESS) present: CHF history, Hematocrit <30%, abnormal ECG, Shortness of breath, Systolic BP <90 mmHg.
Pearls and pitfalls
- External validation performance has varied substantially (sensitivity 74-98%) across populations.