San Francisco Syncope Rule
Patients with unexplained syncope can be risk stratified with these criteria.
Syncope is common and is a common reason for seeking medical attention. The vast majority of syncope is benign, however occasionally syncope can be a sign of a life-threatening disease.
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Follow institutional guidelines for evaluation of syncope; consider admission and telemetry monitoring, especially for patients with any of the SF Syncope Criteria.
Series of Yes/No Questions; if any answered “Yes” patient cannot be considered “Low Risk.”
Facts & Figures
This rule has a 96% sensitivity and 62% specificity for serious outcome - negative predictive value: 99.2%; positive predictive value 24.8%. However, an external validation at the Albert Einstein College of Medicine showed a lower sensitivity of 74%.
Serious outcome in this study is defined as "death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing a return ED visit and hospitalization for a related event."
Original/Primary ReferenceQuinn J, McDermott D, Stiell I, Kohn M, Wells G. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006 May;47(5):448-54. Epub 2006 Jan 18. PubMed PMID: 16631985.
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