San Francisco Syncope Rule (CHESS)

Congestive Heart Failure

Hematocrit <30% (Hb<90)

Electrocardiogram abnormal

Shortness of Breath

Systolic Blood Pressure <90 mmHg at triage


Positive: One of criteria above

Negative predictive value for serious outcome 99.2%


Quinn JV, Stiell IG, McDermott DA, Kohn MA, Wells GA.
Derivation of the San Francisco Syncope Rule to predict patients with short-term serious outcomes.
Quinn (2004) Ann Emerg Med 43:224-32

Quinn JV, McDermott DA, Stiell IG, Kohn MA, Wells GA.
Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes.
Ann Emerg Med. 2006 May;47(5):448-54.

Richard Pearson 2014