Use in adult patients presenting with syncope or near-syncope who are back to their neurologic baseline. Do not use in patients with persistent or new neurologic deficits, alcohol or drug-related loss of consciousness, definite seizure, or transient loss of consciousness from head trauma.
Emergency physician gestalt has been found to be 100% sensitive and 30% specific for identifying high-risk syncope (Sun 2007). Even at best, the SF Syncope Rule is not 100% sensitive, so if there is any concern for serious underlying disease, the patient should undergo further workup. While no serious clinical outcomes were missed, many low-risk patients were unnecessarily admitted to the hospital (the goal of the study was to decrease unnecessary admissions while retaining high sensitivity). Validation studies were not able to replicate the high sensitivity found in the original studies published by the creators of the rule.
From Quinn et al, 2005.
Clinician judgment should prevail, even if patients are deemed low risk by the San Francisco Syncope Rule. If there is significant concern for a serious underlying cause of the patient’s syncope, workup should be expanded.