Validation of San Fransisco Syncope Rule
This month's Annals (May 2006) has an article from Quinn et al. (QuinnAEM-5-06) purporting to validate the San Fransisco Syncope Rule. Also known as "CHESS", the "rule" is positive if any one of the following is true:
- CHF in the past medical history
- Hematocrit < 30
- EKG shows nonsinus rhythm or new changes
- Shortness of Breath
- Systolic < 90 mmHg
In a prospective cohort series, the rule was 98% sensitive (95%CI = 89-100%), 56% specific in predicting "adverse events" within 30 days. Basically, scoring a negative on the San Fransisco rule can make you feel better about sending a patient home. Though, let's be honest, if the test is really 89% sensitive (as the confidence interval allows) than this rule creates an "unnaceptably high" rate of serious outcomes. More below! Read more »
