San Francisco Syncope Rule: Less Sensitive Than Previously Reported

Most patients who present with syncope have benign etiologies, but, for some, syncope is caused by a potentially life-threatening condition. Differentiating between the two etiologies is often difficult in an emergency department, and, as a result, many patients are admitted who might not require inpatient work-up. The San Francisco Syncope Rule was developed to identify low-risk syncope, and the original study reported 96% sensitivity for detection of short-term (7-day) serious outcomes, defined as death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing or likely to cause a return ED visit and hospitalization for a related event. Although sensitivity wa…