San Francisco syncope rule (CHESS)
Identifies syncope patients at risk of serious outcomes within 7 days.
Inputs
History of congestive heart failure
Hematocrit below 30%
Abnormal ECG (new changes or non-sinus rhythm)
Shortness of breath
Systolic BP below 90 mmHg at triage
Worked calculation
Your values are highlighted.
- Criteria present
When to use
- Syncope or near-syncope in the ED.
Pearls and pitfalls
- Validation studies show lower sensitivity than the derivation; use alongside clinical judgment.
- The Canadian Syncope Risk Score is an alternative.
Why use
Five quick items.
Positive if any criterion is present