Clinical decision rule to help risk stratify low versus high risk syncope.

Exclusion criteria: trauma, alcohol, drug-related loss of consciousness, or definite seizure.

ANY of the above places the patient at increased risk and admission should be strongly considered.

This rule cannot safely exclude the need for admission, as an independent validation study (cited below) found the sensitivity 74%, specificity 57%, and NLR 0.5.

 

Quinn J et al. Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006; 47(5):448-54.

Birnbaum A et al. Failure to validate the San Francisco Syncope Rule in an independent emergency department population. Ann Emerg Med. 2008; 52(2):151-9.