San Francisco syncope rule

Introduction

5 variables predict serious outcomes* in patients presenting with syncopal episode

• abnormal electrocardiogram
• shortness of breath
• systolic blood pressure < 90 mm Hg
• hematocrit < 30%
• history of congestive heart failure

Sensitivity 96%

Specificity 62%

Hospitalizing patients with at least 1 positive predictive variable would yield 45% hospitalization compared with 55% hospitalization which occurred without using rule.

* serious outcome defined as death, myocardial infarction, cardiac arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, other significant hemorrhage, other condition likely to lead to return emergency department visit