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      Calc Function

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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
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    Patent Pending

    San Francisco Syncope Rule

    Predicts risk for serious outcomes at 7 days in patients presenting with syncope or near-syncope.

    INSTRUCTIONS

    Use in adult patients presenting with syncope or near-syncope who are back to their neurologic baseline. Do not use in patients with persistent or new neurologic deficits, alcohol or drug-related loss of consciousness, definite seizure, or transient loss of consciousness from head trauma.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Adult patients presenting to the emergency department with syncope or near syncope of unknown etiology who are back to their neurologic baseline.

    • Do not use if any of the following:

      • Persistent altered mental status or new neurologic deficits.

      • Alcohol or drug-related loss of consciousness.

      • Definite seizure.

      • Transient loss of consciousness due to head trauma.

    • The most common serious outcome in the studies was cardiac dysrhythmia. Most were bradydysrhythmia or sick sinus syndrome, the remainder were supraventricular or ventricular dysrhythmias.

    • Other common serious outcomes misclassified as low risk were stroke and intracranial hemorrhage (see Evidence for details).

    • Note that validation studies were not able to replicate the high sensitivity found in the original studies published by the creators of the rule.

    • A commonly used mnemonic to recall the five variables is “CHESS”:

      • Congestive heart failure (history of).

      • Hematocrit under 30%.

      • EKG abnormal.

      • Shortness of breath.

      • Systolic blood pressure less than 90 mmHg.

    • Syncope may be relatively benign or a manifestation of serious underlying pathology.

    • ED physician gestalt is highly sensitive but poorly specific for predicting high risk patients. The creators designed the rule to improve specificity while maintaining high levels of sensitivity.

    • The tool can be utilized to predict low risk syncope patients who would not likely benefit from aggressive work-up and hospitalization, thus reducing unnecessary testing, healthcare costs, and potential harms associated with hospitalization.

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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Ian Stiell

    About the Creator

    Ian Stiell, MD, MSc, FRCPC, is Professor and Chair, Department of Emergency Medicine, University of Ottawa; Distinguished Professor and University Health Research Chair, University of Ottawa; Senior Scientist, Ottawa Hospital Research Institute; and Emergency Physician, The Ottawa Hospital. He is internationally recognized for his research in emergency medicine with a focus on the development of clinical decision rules and the conduct of clinical trials involving acutely ill and injured patients treated by prehospital services and in emergency departments. He is best known for the development of the Ottawa Ankle Rule, the Canadian C-Spine Rule, and Canadian CT Head Rule and as the Principal Investigator for the landmark OPALS Studies for prehospital care. Dr. Stiell is the Principal Investigator for 1 of 3 Canadian sites in the Resuscitation Outcomes Consortium (ROC) which is funded by CIHR, NIH, HSFC, AHA, and National Defence Canada. Dr. Stiell is a Member of the Institute of Medicine of the U.S. National Academies of Science.

    To read more about Dr. Stiell's work, visit his website.

    To view Dr. Ian Stiell's publications, visit PubMed

    Are you Dr. Ian Stiell? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. James V. Quinn

    About the Creator

    James V. Quinn, MD, MS, is a professor of emergency medicine at Stanford University School of Medicine. He is also the director of research in the emergency medicine department at Stanford University and serves as a member of the Scientific Advisory Board for iRhythm Technologies, Inc. Dr. Quinn’s primary research is focused on management of syncope.

    To view Dr. James V. Quinn's publications, visit PubMed

    Content Contributors
    Reviewed By
    • Marc Probst, MD, MS
    About the Creator
    Dr. Ian Stiell
    Are you Dr. Ian Stiell?
    Dr. James V. Quinn
    Content Contributors
    Reviewed By
    • Marc Probst, MD, MS