| Abnormal EKG | Yes No |
| Shortness of breath | Yes No |
| Hematocrit<30% | Yes No |
| SBP<90 mmHg | Yes No |
| History of CHF | Yes No |
Information:
The San Francisco Syncope Rule (SFSR) was developed to aid Emergency and Acute Care Physicians in determination of which patients presenting to the ED with syncope or near syncope are at risk of serious short-term outcomes (within 7 days). This determination may help in the decision for admission versus outpatient evaluation.
Score Details:
If any of the following is present; the SFSR indicates higher risk of serious outcome (e.g. patient needs admission)
Discussion:
The original study showed 96% sensitivity (which still had 4% miss rate) for serious adverse outcomes at 7 days. Serious outcomes include death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, intracranial hemorrhage, significant hemorrhage, or other condition causing a return to the ED or hospitalization for a related event.
In a prospective study, this score did not fare as well (Fischer, et al), with 50 patients of 362 having a serious outcome and the SFSR only identifying 26 of these (However the duration was serious outcome at 30 days, whereas the original study was at 7 days).
References:
Fishcer C et al. External Validation of the San Francisco Syncope Rule. Acad Emerg Med 2005:12(5):Suppl 1/127.
Peterson JF. A Prediction Rule for Serious Outcomes of Syncope in Emergency Room Patients May Reduce Admission. JCOM. April 2004;11(4):196.
Quinn JV et al. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med Feb 2004;43:224-32.