San Francisco Syncope Rule (FED 30 90)

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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