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san francisco syncope rule

San Francisco Syncope Rule (FED 30 90)

Epomedicine, Oct 28, 2017Oct 28, 2017

Last updated on October 28, 2017

San Francisco Syncope Rule (SFSR) defines high risk criteria for patients with syncope.

san francisco syncope rule

FED 30 90

  1. Failure (Congestive heart failure)
  2. ECG abnormalities
  3. Dyspnea (shortness of breath)
  4. Hematocrit <30%
  5. Systolic blood pressure <90 mmHg (at any time)

Presence of any of the above criteria is regarded as positive.

Mnemonic: CHESS

  1. Congestive heart failure
  2. Hematocrit <30%
  3. ECG abnormality
  4. Shortness of breath
  5. Systolic blood pressure <90 mmHg

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.”

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Emergency Medicine Cardiovascular systemEmergency medicine

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Epomedicine. San Francisco Syncope Rule (FED 30 90) [Internet]. Epomedicine; 2017 Oct 28 [cited 2025 May 29]. Available from: https://epomedicine.com/emergency-medicine/san-francisco-syncope-rule-fed-30-90/.

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