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- Syncope is defined as a transient loss of consciousness and accounts for an estimated 1% to 3% of emergency department (ED) visits.
- While syncope typically is of benign origin, it occasionally signals significant mortality and morbidity, which can make determining the disposition of syncope patients a challenge.
- The San Francisco Syncope Rule (96% sensitivity, 62% specificity) is a clinical tool used to determine which syncope patients are at low risk for a short-term (7-day) serious outcome (i.e. MI, arrhythmia, PE, stroke, SAH, significant hemorrhage, any condition causing or likely to cause a return ED visit or hospitalization).
Specifically, absence of all of the following 5 findings (acronym CHESS) were associated with no serious outcome within 7 days of the syncopal episode according to this rule:- Congestive heart failure
- Hematocrit less than 30
- EKG Abnormalities
- Systolic BP less than 90
- Shortness of breath
- While this decision rule, in addition to one's clinical skill, may be used as a guide in caring for and dispositioning syncopal patients, know that its ability to be extrapolated to a general population of ED patients has yet to be validated.
References
- Birnbaum A, et al. "Failure to Validate the San Francisco Syncope Rule in an Independent Emergency Department Population." Annals of Emergency Medicine. August 2008, 52 (2): 151-9.
- Quinn J, et al. "Derivation fo the San Francisco Syncope Rule to Predict Patients with Short Term Serious Outcome." Annals of Emergency Medicine. Febuaruy 2004, 43(2).