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The San Francisco Syncope rule identifies patients who cannot be considered low risk of adverse outcomes after a syncopal event.
Criteria include:
History of congestive heart failure
Hematocrit <30%
Abnormal EKG (New ECG change from any source, any non-sinus rhythm on EKG or monitoring)
Symptoms of shortness of breath
Systolic BP <90 mmHg at triage
If any of these criteria are noted, patient cannot be considered "low risk" of a serious outcome. In this study, a serious outcome 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."
While the original paper identified a 96% sensitivity and 62% specificity for serious outcome (with negative predictive value 99.2% and positive predictive value 24.8%), validation studies have reported inconsistent results.
References
Quinn 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.
Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ.
Failure to validate the San Francisco Syncope Rule in an independent emergency department population.
Ann Emerg Med. 2008 Aug;52(2):151-9. Epub 2008 Feb 20.
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