San Francisco Syncope Rule (SFSR)
Identifies ED patients with syncope at risk for serious outcomes within 7 days (arrhythmia, MI, PE, intracranial haemorrhage, death). ANY criterion positive = high risk.
Score interpretation
No SFSR criteria met. Low risk of serious outcome within 7 days.
→ Safe for discharge with safety-netting. Driving restrictions as per DVLA. Outpatient cardiac monitor (Holter) if no clear cause. Return if recurrent.
One or more SFSR criteria met. High risk of serious 7-day adverse event.
→ Admit for monitored observation. ECG telemetry. Cardiology review. Echocardiogram. Identify and treat underlying cause.
Interpretation bands for the SF Syncope Rule. Apply clinical judgement and local guidance.
References
- Quinn JV, et al. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes. Ann Emerg Med. 2004;43(2):224–232.
Related
Curated clinical cross-links plus same-class fallbacks.
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Ziprasidone · Atypical Antipsychotic — D2/5-HT2A Antagonist (Low Metabolic Risk)
- Atorvastatin (CKD Cardiovascular Risk) · Cardiovascular Risk in CKD
- Icosapent Ethyl (Omega-3 — Cardiovascular Risk Reduction) · Omega-3 Fatty Acid (Purified EPA — Eicosapentaenoic Acid Ethyl Ester)
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.