San Francisco Syncope Rule

Identify those at low risk of adverse outcome after a syncopal episode

The global unit selector only affects unanswered questions
1.History of Heart Failure?
2.Hematocrit <30%?
3.Abnormal ECG?
4.History of Dyspnea?
5.Systolic BP <90 mmHg?
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1. History of Heart Failure?

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About this Calculator

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.


Quinn J, McDermott D, Stiell I, Kohn M, Wells G.

Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes.

Annals of Emergency Medicine 2006, 47 (5): 448-54

Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ.

Failure to validate the San Francisco Syncope Rule in an independent emergency department population.

Annals of Emergency Medicine 2008, 52 (2): 151-9

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