Neurology Emergency Medicine Cardiology A
San Francisco Syncope Rule (SFSR)
Identifies ED syncope patients at risk of serious outcome within 7 days. Any criterion positive = high risk. CHESS mnemonic.
Used in: Syncope
Score interpretation
Low Risk — SFSR Negative 0
No criteria met. 7-day serious outcome risk <1%. Sensitivity ~98%, Specificity ~56%.
→ Safe for discharge with follow-up. Tilt-table test or Holter if recurrent unexplained syncope.
High Risk — SFSR Positive 1–5
One or more criteria positive. High risk of 7-day serious event.
→ Admission for monitoring and investigation. ECG, echo, Holter. Cardiology review.
Interpretation bands for the SFSR. 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.
Calculators
- ADHERE Algorithm for Acute Decompensated Heart Failure · Risk Stratification
- TIMI Risk Index for STEMI · Risk Stratification
- LACE Index for Readmission Risk · Risk Stratification
- Charlson Comorbidity Index (CCI) — Detailed · Risk Stratification
- GI-BLEED Score for Upper GI Bleeding · Risk Stratification
- HCT-CI — Haematopoietic Cell Transplant Comorbidity Index · Risk Stratification
Drugs
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Terlipressin · Gastrointestinal Emergency
- Octreotide · Gastrointestinal Emergency
Pathways
- 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.