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Patients with syncope often are admitted to the hospital despite negative emergency department (ED) evaluations. The San Francisco Syncope Rule was developed to identify syncope patients who are at sufficiently low risk for serious outcomes to be safely discharged home after ED evaluation. The rule classifies patients as high risk if they have histories of congestive heart failure, hematocrit <30%, abnormal electrocardiogram, shortness of breath, or triage systolic blood pressure <90 mm Hg. The rule was initially reported to have 96% and 98% sensitivity for predicting serious outcomes at 7 days and 30 days, respectively, but has not performed as well in subsequent validation studies in the U.S. and Australia, where sensitivities ranged from…