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Printed on 4/19/2026
For informational purposes only. This is not medical advice.
The San Francisco Syncope Rule (SFSR) uses five high-risk features (CHESS) to identify patients with potentially increased risk of serious outcomes after syncope: history of CHF, hematocrit under 30%, abnormal ECG, shortness of breath, and systolic blood pressure under 90 mmHg.
Formula: SFSR is positive if any CHESS criterion is present.
The San Francisco Syncope Rule was developed to identify short-term serious outcome risk in ED syncope patients.
Presence of one or more CHESS criteria indicates higher risk by rule and supports more cautious disposition planning. Absence of CHESS criteria indicates lower risk by rule but does not eliminate all risk.
Use SFSR alongside comprehensive syncope evaluation.
Use SFSR during ED syncope assessment after initial stabilization and basic workup, to support structured short-term risk communication.
It is most useful as an adjunct in disposition discussions (discharge vs observation/admission).
Rule performance varies across validation cohorts, and definitions of ECG abnormality can differ by institution.
SFSR should not override concerning clinical trajectory or other high-risk features not captured by CHESS.
For related assessments, see qSOFA Score, Shock Index and MAP Calculator.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
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